CMS’ Goodrich: More MACRA Relief On the Way | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

CMS’ Goodrich: More MACRA Relief On the Way

March 19, 2018
by Rajiv Leventhal
| Reprints
More program flexibilities will be coming in 2018

The Centers for Medicare & Medicaid Services (CMS) said last week that more changes will be coming this year to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)—including the alignment of quality measures between hospitals and hospital-employed physicians.

Kate Goodrich, M.D., director of the Center for Clinical Standards and Quality and the chief medical officer at CMS, said at a meeting last week in Washington, D.C, as reported by the Healthcare Financial Management Association (HFMA), that the lack of that quality measurement alignment has hindered quality reporting during the first years of the MACRA law.

“The measures are basically the same, but what people have to do—the rules of the road, if you will—on the scoring are very different between the two,” Goodrich said, referring to hospitals and their employed physicians. “And that creates problems for health systems that use a single [electronic health record (EHR)] to report on behalf of clinicians and to report on behalf of hospitals,” she said, as reported by HFMA.

Indeed, the implementation of facility-based scoring by CMS would aim to help physicians who want to use their hospital’s quality-measure performance for reporting under one of MACRA’s payment tracks—Merit-based Incentive Payment System (MIPS). “This gets to an alignment of incentives between hospitals and the clinicians who work in those hospitals in terms of what they are focused on for improvement and ultimately for accountability,” Goodrich said at the meeting.

Goodrich also brought up the Bipartisan Budget Act of 2018 (BBA), noting that CMS is looking at “overhauling” MACRA—including through simplification of the data submission process, per the legislation. Specifically, CMS is looking at each quality measure that physicians are required to report under MACRA and will consider dropping any measure that is underperforming or “topped out.”

As Healthcare Informatics reported last month, as part of the BBA, lawmakers proposed that for each of the second, third, fourth and fifth years for which MIPS applies to payments, a clinician’s cost-cutting would never be less than 10 percent and never more than 30 percent. In other words, the “Cost” category of MIPS—one category that determines a clinician’s final MIPS score—could be weighted at just 10 percent through 2021, given this new legislation. As per the MACRA 2018 final rule that was released last fall, CMS had originally intended to have the Cost category jump from 10 percent of a clinician’s score in 2018 all the way up to 30 percent of the overall score in 2019.

At the core of these approaches, noted Goodrich, is to reduce the regulatory burden that MACRA/MIPS places on providers. “We continue to hear that the program is still too complicated,” Goodrich said. “People are glad we’ve allowed for a lot of flexibilities, but what that does is makes things complicated. We’ve gotten some very specific ideas about ways we can further simplify the scoring in some of the policies.

As the HFMA report noted, the BBA included other important provisions for MIPS, removing Medicare Part B drug costs as a factor in MIPS payment adjustments and in low-volume threshold determinations for required MIPS participation. CMS plans to update by the end of March which physicians will be required to report under MIPS.

The administration also is working with EHR vendors and registries to search for ways to automatically extract required quality data from electronic records with little or no action required by physicians.

Nonetheless, these efforts will not produce another delay in implementing requirements that providers adopt 2015-edition EHR technology as part of the EHR meaningful use program. “We’ve delayed this a couple years, but last year we finalized that this would be required starting in 2019; we are not backing down on that, so we are not changing that and will reiterate that" in upcoming payment rules, Goodrich said, per the HFMA report.

Goodrich also affirmed the administration’s position on moving more physicians into advanced APMs (alternative payment models) as part of MACRA. This continues as a “top strategic goal” of CMS, she said.

Get the latest information on Health IT and attend other valuable sessions at this two-day Summit providing healthcare leaders with educational content, insightful debate and dialogue on the future of healthcare and technology.

Learn More



Mass. General, Eastern Maine Healthcare Systems Form Clinical Affiliation

Massachusetts General Hospital will form a clinical affiliation with Eastern Maine Healthcare Systems, in which the two provider organizations will collaborate on areas as telemedicine, research, and protocols for providing care, according to a report in the Boston Globe.

Humanitarian Data Exchange Wins Health Data Liberator Award

Sarah Telford and Ahmadou Dicko were named the winners of this year’s Health Data Liberator award at the Health Datapalooza conference in Washington, D.C., for their work on the Humanitarian Data Exchange.

Survey: Optimism for Health IT Startups in 2018, Skepticism for Amazon Healthcare Partnership

Despite all the buzz about new entrants disrupting healthcare, the majority of healthcare stakeholders are dubious about the impact of the Amazon/Berkshire Hathaway/JP Morgan healthcare partnership and believe the effort will face substantial challenges, according to a survey by venture capital firm Venrock.

NIH Awards $10M to Alabama-based Newborn Genome Sequencing Project

The National Institutes of Health (NIH) has awarded a four-year, $10 million grant to HudsonAlpha Institute for Biotechnology, a Huntsville, Ala.-based genomics and genetics research institute, in collaboration with the University of Alabama at Birmingham (UAB) School of Medicine and the University of Mississippi Medical Center, to investigate how genome sequencing can help with the diagnosis and care of babies with birth defects and genetic disorders.

Senate Committee Advances Opioid Bill that Includes Telehealth Provisions

The Senate Health, Education, Labor and Pensions (HELP) Committee voted Tuesday to advance a bipartisan opioid bill, called the Opioid Crisis Response Act of 2018, that includes provisions promoting the use of telemedicine in substance abuse treatment.

Florida Insurer Establishes Digital Health and Wellbeing Program for Members

Florida Blue, a health insurer based in Jacksonville, has announced a partnership with Welltok. The goal of the collaboration will be to provide Florida Blue members with access to a digital health and wellbeing program designed to help them become and stay healthy.