MACRA Final Rule Now Under Review at OMB | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

MACRA Final Rule Now Under Review at OMB

September 16, 2016
by Rajiv Leventhal
| Reprints

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.

 

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

Topics

News

Study will Leverage Connecticut HIE to Help Prevent Suicides

A new study will aim to leverage CTHealthLink, a physician-led health information exchange (HIE) in Connecticut, to help identify the factors leading to suicide and to ultimately help prevent those deaths.

Duke Health First to Achieve HIMSS Stage 7 Rating in Analytics

North Carolina-based Duke Health has become the first U.S. healthcare institution to be awarded the highest honor for analytic capabilities by HIMSS Analytics.

NIH Releases First Dataset from Adolescent Brain Development Study

The National Institutes of Health (NIH) announced the release of the first dataset from the Adolescent Brain Cognitive Development (ABCD) study, which will enable scientists to conduct research on the many factors that influence brain, cognitive, social, and emotional development.

Boston Children's Accelerates Data-Driven Approach to Clinical Research

In an effort to bring a more data-driven approach to clinical research, Boston Children’s Hospital has joined the TriNetX global health research network.

Paper Records, Films Most Common Type of Healthcare Data Breach, Study Finds

Despite the high level of hospital adoption of electronic health records and federal incentives to do so, paper and films were the most frequent location of breached data in hospitals, according to a recent study.

AHA Appoints Senior Advisor for Cybersecurity and Risk

The American Hospital Association (AHA) has announced that John Riggi has joined the association as senior advisor for cybersecurity and risk.