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BREAKING NEWS: CMS Announces Long-Awaited MACRA Proposed Rule; Program Includes MU Makeover for MDs

April 27, 2016
by Mark Hagland
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CMS officials announce their plan to replace meaningful use requirements for physicians

In a dramatic policy move, federal healthcare officials announced on Wednesday afternoon, Apr. 27, that the Centers for Medicare & Medicaid Services (CMS) is introducing a new program that will replace the meaningful use program under the HITECH (Health Information Technology for Economic and Clinical Health) Act, for physicians participating in the Medicare program (for the moment, hospitals will be unaffected). The new program, called Advancing Care Information (ACI), was introduced Wednesday as a Notice of Proposed Rulemaking by the Department of Health and Human Services (HHS), under the terms of the Medicare Access and CHIP Reauthorization Act (MACRA).

The new program, with its associated changes, was announced on the CMS website, and via two succeeding press conferences, the first one involving Andy Slavitt, Acting CMS Administrator, and Patrick Conway, M.D., Deputy Administrator for Innovation & Quality and Chief Medical Officer for the agency, and the second one involving Slavitt and Karen DeSalvo, M.D., National Coordinator for Health IT, along with Kate Goodrich, M.D., Director of the Center for Clinical Standards and Quality at CMS.

Details of the announcement were included online in The CMS Blog, and can be read here. In that announcement-blog, co-authors Slavitt and DeSalvo wrote that “Over the last several months, we have made an unprecedented commitment to listening to and learning from physicians and patients about their experience with health information technology – both the positive and negative. We spoke with over 6,000 stakeholders across the country, including clinicians and patients, in a variety of local communities. Today, based on that feedback, we are proposing to incorporate the program in to the Merit-based Incentive Payment System (MIPS) in a way that makes it more patient-centric, practice-driven and focused on connectivity. This new program within MIPS is named Advancing Care Information.”

Stating that “Our goal with Advancing Care Information is to support the vision of a simpler, more connected, less burdensome technology,” Slavitt and DeSalvo wrote in the announcement-blog that, “Compared to the existing Medicare Meaningful Use program for physicians, the new approach increases flexibility, reduces burden, and improves patient outcomes,” because among other things, it will:

> Allow physicians and other clinicians to choose to select the measures that reflect how technology best suits their day-to-day practice

> Simplify the process for achievement and provide multiple paths for success

>  Align with the Office for the National Coordinator for Health Information technology’s 2015 edition Health IT Certification Criteria

> Emphasize interoperability, information exchange, and security measures and give patients access to their information through APIs (application program interfaces)

>  Reduce the number of measures to an all-time low of 11 measures, down from 18 measures, and no longer require reporting on the clinical decision support and computerized provider order entry measures

>  Exempt certain physicians from reporting when EHR technology is less applicable to their practice and allow physicians to report as a group

In his introductory remarks during the first press conference, Slavitt told journalists, “Today’s healthcare system as a nation, we often don’t pay physicians and clinicians for the best care they can give. Across the country, we believe there’s an opportunity to provide high-quality care while saving money. We agree that we need to move our system to one that delivers high-quality care. Thanks to the bipartisan MACRA legislation passed last year and supported by many stakeholders, we’ve had the tools So today, we’ve announced the next major step in Medicare payment reform.”

Andy Slavitt

In comments regarding physicians’ options of participating either in approved alternative payment models or in the new MIPS (Meri-based Incentive Payment Program), under the MACRA law, Dr. Conway acknowledged that the uptake of physician participation in alternative payment models will inevitably be a gradual one. “In the first year,” he said, most physicians will most likely participate in the Quality Payment Program through MIPS.” Under this newly announced Advancing Care Information program, he said, “Physicians would select quality measures from a range of measures, and would report technology use.” The program will “simplify measures and eliminate redundant quality reporting. If clinicians do well in the program, they could earn more than a 4-percent quality bonus, with additional bonuses. CMS proposes to be measuring performance for doctors and other clinicians in 2017, with payment adjustments beginning in 2019,” he added.

So how will the introduction of this program affect physicians’ participation in the current meaningful use program? Under MU, participating physicians must complete Stage 2 requirements during program year 2016, with penalties ending in 2018. That is still true. What will happen with the introduction of the Advancing Care Information program is that physicians will be scored based on a range of measures, and if they are unable to report the successful use of approved information technology under the MIPS program, they would receive a 0 in that reporting category that would bring down their average score under MIPS. Similarly, all the alternative-payment model programs involve performance measures related to the successful use of EHRs and other clinical IT.