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Watching CMS Listen to Providers

May 3, 2016
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Last week’s announcement of significant changes to Medicare physician payment speaks to an increased willingness on the part of CMS officials to listen to providers’ concerns

Last week was a fascinating week in healthcare policy, for those who have been tracking policy issues for the last few years. The Centers for Medicare & Medicaid Services’ (CMS) announcement last week Wednesday was quite significant, along a number of dimensions.

As we reported last week, “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,” we wrote, “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.”

The proposed rule published by CMS last week has many implications, including many implications around healthcare IT and outcomes measures reporting, as it essentially “folds in” the meaningful use program into the new “Advancing Care Information” program under the MIPS (Merit-based Incentive Payment Program), for Medicare-accepting physicians. And even though CMS officials made clear that hospitals are not affected by last week’s announcement and proposed rule, CMS’s Slavitt also noted that he and other CMS officials were actively dialoguing with hospital leaders about what to do about MU on the hospital side as well.

Here’s the thing: for all those in the industry who have been (sometimes quite loudly) complaining that CMS officials “never listen” when it comes to concerns and dissatisfaction from healthcare providers, it seems quite clear this time around that CMS officials have in fact been listening. Of course, officials’ hands are at least partly tied: because the meaningful us program originated as part of the HITECH (Health Information Technology for Economic and Clinical Health) Act under the ARRA (American Recovery and Reinvestment Act), they cannot simply “scrap” meaningful use; that is not one of their options.

What’s more, their options are further constrained by the passage by Congress of MACRA a year ago. So CMS officials, facing mounting dissatisfaction among both physicians and hospitals around some of the rigidities embedded in MU, chose to do something very practical: they took the provisions of MACRA/MIPS and refashioned some of the MU requirements, and moved them under MIPS. Et voila!

Is it a perfect solution? No. No solution to some of the problems that had emerged under meaningful use could be perfect. But what their move does do is to streamline some requirements, and move the rest under a new superstructure that was being put in place anyway. And it aligns well with a number of other moves that CMS has been making to align a variety of payment shifts towards value-based payment, across both the acute-care and ambulatory care sectors.

Leslie Kriegstein, vice president of congressional affairs at the College of Healthcare Information Management Executives (CHIME), wrote this in her Washington Debrief for Healthcare Informatics on Monday, “Why it Matters: In an unusual move, CMS published the long-anticipated proposed rule on the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) program stemming from the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) of 2015. Collectively, CMS is referring to these programs as the Quality Payment Program. CMS says their goal with the Quality Payment Program is to continue to support health care quality, efficiency, and patient safety. MACRA reforms the long-time sustainable growth rate formula dictating the way physicians and other clinicians are paid,” Kriegstein noted, “and replaces it with a new system that rewards value and outcomes.  The law also consolidates the current Meaningful Use, Physician Quality Reporting System, and Value-based Payment Modifier programs.  Components of each are a part of the new system.”