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MACRA Final Rule Now Under Review at OMB

September 16, 2016
by Rajiv Leventhal
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The Centers for Medicare & Medicaid Services (CMS) has sent the highly-anticipated Medicare Access and CHIP Reauthorization Act (MACRA) final rule to the White House Office of Management and Budget (OMB) for review. This seemingly means that the proposed rule from April, set to overhaul physician payment as the government shifts to paying doctors for value rather than volume, is indeed set to become final by Nov. 1, as scheduled.

There had been speculation that the MACRA rule would be delayed from its intended Jan. 1, 2017 start date, as CMS Acting Administrator Andy Slavitt hinted at this summer, but that looks to no longer be the case. Last week, CMS announced that it will allow physicians to pick their pace of participation for the first performance period of MACRA that begins in January, and will result in physician payment adjustments in 2019. With these new flexibilities announced by CMS, eligible Medicare physicians will be given options to ease into the first year of the program.

While there are concerns about how physicians, especially small doctor practices, will adjust to the new law, much of the industry seemed to be relieved with the recent flexibilities granted by the government. Slavitt said participating providers will have four pathways to choose from for the first year of MACRA in 2017. These pathways range from sending in only some data to MACRA’s Quality Payment Program, which includes two paths—the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs); to sending in more data but for a reduced period of time; to “going all in” as is.

As John David Goodson, M.D., staff internist at Massachusetts General Hospital (MGH) and associate professor at Harvard Medical School, opined in a recent interview with Healthcare Informatics, these pathways laid out by the federal agency are attempts to at the least, get the community of providers engaged at a minor level in the first year of the program. This will be necessary as MACRA’s Quality Payment Program will require good, solid data which “CMS will never get unless they get doctors to buy into the reporting mechanisms,” Goodson said.

Now, the healthcare industry will anxiously await the MACRA final rule to see how it differs from what was proposed. There are various key health IT elements in the rule, including a new Meaningful Use program, dubbed “Advancing Care Information (ACI),” which accounts for 25 percent of an eligible physician’s (EP) total score under MIPS.  According to the proposed rule, in addition to the Advancing Care Information program, doctors will be scored on Quality (50 percent of total score in year 1); Clinical Practice Improvement Activities (15 percent of total score in year 1); and Cost (10 percent of total score in year 1). Overall, how EPs score within each of these four areas will determine their reimbursement amounts for health IT.

As Healthcare Informatics previously reported, healthcare professional associations’ official comments to CMS regarding the proposed rule included requests that CMS officials make major modifications to value-based concepts under MACRA, as well as numerous types of requests for changes in the final rule around measurements and other elements in the MIPS program.




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