CMS Unveils Proposed Rule Implementing MACRA and Replacing Meaningful Use

In January, the Centers for Medicare & Medicaid Services (CMS) Acting Administrator Andy Slavitt indicated that the “Meaningful Use program as it has existed, will now be effectively over and replaced with something better.” (See National Intelligence Report, 1/28/16, p. 6.) CMS has now issued a proposed rule providing a look at that something better. “[W]e are proposing to incorporate the [Meaningful Use] program [into] the Merit-based [Incentive] Payment System (MIPS) in a way that makes it more patient-centric, practice-driven and focused on connectivity. This new program within MIPS is named Advancing Care Information,” said Slavitt and Dr. Karen DeSalvo, national coordinator, Office of the National Coordinator for Health IT, in a CMS Blog.

Slavitt’s and DeSalvo’s blog statement was made in connection with the April 27 release of a proposed rule to implement the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA was signed into law April 16, 2015, and repealed the sustainable growth rate formula and emphasized the new Merit-Based Incentive Payment System (MIPS) and incentive payments for participation in certain Alternative Payment Models (APMs).

The U.S. Department of Health & Human Services said in its announcement of the proposed rule that currently, “a patchwork of programs” measures value and quality of care. The proposed rule on the other hand provides a “unified framework called the Quality Payment Program” consisting of the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). The goal of the proposal is to provide flexible, practical ways to measure performance that work with the way physicians practice medicine rather than a “one-size-fits-all program.” U.S. Department of Health and Human Services Secretary Sylvia Burwell said the program allows “every doctor … to be paid more for better care” and have “more freedom to care for patients the way they were trained, the way that makes the most sense to them and is best for the patients.”

MIPS will “consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals (EPs)” but will continue to emphasize quality, resource use, and use of certified EHR technology (CEHRT). MIPS measures value through four performance categories:

• Quality—physicians must report on six measures chosen “from among a range of options that accommodate differences among specialties and practices.”
• Advancing Care Information—providers can select “customizable measures” for reporting their day-to-day use of technology and demonstrate interoperability. CMS says the goal is to provide a more flexible approach than the current Meaningful use program and allow physicians to choose measures based on their own daily practice and eliminating “all-or-nothing EHR measurement.”
• Clinical Practice Improvement Activities—practice improvement activities (chosen from a list of 90 activities) such as care coordination and patient safety will be rewarded.
• Cost—based not on physician reporting but on Medicare claims data that use “40 episode-specific measures.”

The proposed rule also encourages participation in alternative payment models (APMs). APM participation will exempt providers from MIPS reporting obligations provided they accept sufficient risk and reward in striving to provide quality, coordinated health care services. Two types of APMs are included in the proposal: Advanced APMs and Other Payer Advanced APMs (both require use of certified EHR technology and providing payment based on quality measures similar to those in MIPS).

“Today’s rule incorporates input from patients, caregivers, clinicians, health care professionals, and other stakeholders, but it represents only the first step in an iterative implementation process,” HHS said in its announcement.

Comments on the proposed rule must be submitted by June 26, 2016. If the proposal is finalized, it would take effect Jan. 1, 2017. The performance period for which measurements will be applied will be 2017 with reporting required in 2018 and payment adjustments will be effected in 2019.

For more information, including informational webinars, fact sheets, training slides, and instructions on how to submit comments regarding the proposed rule, see CMS’ website.

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