In a press conference on the morning of Oct. 14, senior officials at the federal Centers for Medicare and Medicaid Services (CMS) discussed the details of the new final rule that the agency had just released on its website, for the finalized and highly anticipated finale rule for the provisions of the new Quality Payment Program under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Final Rule, which has been finalized by the Department of Health & Human Services (HHS). The MACRA legislation, passed in the spring of 2015, replaced the provisions of the Sustainable Growth Rate (SGR) formula for physician payment under Medicare that had been prevailing for years.
(For an analysis of some of the provisions of the final rule, please turn to this article by Healthcare Informatics Senior Contributing Editor David Raths.)
Three senior federal healthcare officials spoke at the telephonic press conference. First to speak was Kristie Canegallo, White House Deputy Chief of Staff for Implementation in the Obama administration. “I want to talk briefly about the President’s enthusiasm for the work represented in the final MACRA rule,” Canegallo said. “Today’s announcement is an important step in this Administration’s commitment to improving quality, affordability and accessibility of US healthcare system. Most of you know that this Administration has worked aggressively to move our healthcare system to one that provides better patient care, spends taxpayer dollars in a smarter way and ultimately leads to healthier individuals, healthier communities and a healthier nation.” Referencing a speech given on Thursday by President Barack Obama, she said, “As you may have heard him talk about just yesterday when we were in Pittsburgh at the Frontiers conference, [the President] spoke about the imperative of incentivizing our healthcare system to look holistically at patients and moving that system to one that provides the right incentives to doctors to think this way.”
Canegallo went on to note that, “Thanks to the incentives in the ACA, hospital-acquired conditions have fallen 17 percent since 2010, saving 87,000 lives and $20 billion in healthcare costs. Over 75 percent of physicians and 95 percent of hospitals have adopted and are using electronic health records. And, 30 percent of Medicare payments are in alternative payment arrangements.”
After Canegallo had concluded her comments, CMS Acting Administrator Andy Slavitt then spoke at length about the philosophy and strategy behind the development of the final rule, saying that “This is a landmark effort to move the healthcare system forward. The Medicare program not only serves 55 million people and works with the vast majority of the nation’s clinicians, but it’s also a promise to the millions of taxpayers, including the 10,000 people who turn 65 every day, to be here when we need it. So transforming something of this size is something that we focused on with great care,” he said.
Slavitt continued, saying that “The policy we’ve finalized is the result of a user-driven policy effort, where our staff put down our pens and went into the field to hear from physicians and patients. Overall, many of us traveled the country and received more than 4,000 comments on our proposed rule, and nearly 100,000 people attended our outreach sessions. This was a good opportunity for us to understand the realities of practices today and what we can do to best support care for their patients, how Medicare and other payers interact with their daily practice, how much time they spend on reporting requirements and how burden takes time away from the practice of medicine.”
Highlighting what he considers to be key elements of the final rule, Slavitt said, “First of all, physicians will be able to pick their own pace of beginning to participate in the program and decide how to gradually increase their involvement in the first several years. We will continue to take comment on the rule so that we can make sure that the program evolves as the healthcare system evolves. Second, we’re offering choices to allow physicians to tailor many elements of the program for their specialty and even their practice.”
In fact, he noted, “Based on significant feedback on how physicians want to interact with the program, we’ve launched today a new one-stop shop portal and service center. The portal, which is at qpp.cms.gov, is designed side by side with physicians and with CMS and the great technology team at U.S. Digital Services, the same team that worked on the relaunch of healthcare.gov. We heard critical feedback to make it easier for physicians to join advanced payment models [APMs], which are locally formed, physician-led approaches to care delivery, like medical homes and bundled payments that pay a 5 percent bonus under MACRA. So, the CMS Innovation Center undertook a number of steps.”
Among other elements, Slavitt noted, “We’re announcing today that we will be adding a significant new option in 2018 that will appeal to smaller practices, called ACO Track 1. It will have lower levels of risk to qualify as an advanced payment model. We’re now in the middle of reviewing and opening other popular models in the CMS Innovation Center to be announced shortly. The Innovation Center is also developing opportunities for specialists to participate in advanced APMs. As already announced, we are opening up episode-based models in cardiology and orthopedics to count as advanced APMs, in addition to the oncology and nephrology models that the Innovation Center has already developed.”