MACRA

"We understand new rules require adjustment and preparation," said Andy Slavitt, Centers for Medicare and Medicaid Services acting administrator.

The physician practice association offered recommendations for the Merit-Based Incentive Payment System and Alternative Payment Models proposed by MACRA – including a reduction of reporting requirements across MIPS.

$20 million will be given each year, for the next five years, to provide training and education for Medicare clinicians.

The American Medical Association and the American Hospital Association call on ONC to rethink how it measures interoperability. Rather than simply gauging data exchange, they contend, ONC should focus on better care coordination.

Many physicians have waited with bated breath for the end of meaningful use, looking forward to a new era of less burdensome compliance requirements and more realistic reporting guidelines. This may not be what they had in mind.

On Twitter, former National Coordinator for Health IT Farzad Mostashari, MD, called it the "most substantive change to how healthcare is paid for in a couple of decades." The propsed MACRA rule put forth by the U.S. Department of Health and Human Services on Wednesday also holds some pretty big changes for how health IT can be put to work by physicians to drive quality improvement and cost efficiencies. [Also: MACRA proposed rule published by HHS, streamlining federal programs including meaningful use] "By proposing a flexible, rather than a one-size-fits-all program, we are attempting to reflect how doctors and other clinicians deliver care and give them the opportunity to participate in a way that is best for them, their practice and their patients," said Patrick Conway, MD, chief medical officer at the Centers for Medicare & Medicaid Services, in announcing the rule. "Reducing burden and improving how we measure performance supports clinicians in doing what they do best – caring for their patients." So far, most industry reaction to the notice for proposed rulemaking is positive – recognizing the fact CMS seems to have taken the feedback from more than 6,000 frontline healthcare stakeholders to heart, crafting a rule that's attuned to the needs of physicians. In a statement, HIMSS applauded the "significantly streamlined reporting and the acknowledgement process for MIPS-eligible clinicians" in the new rule. "We are encouraged by CMS's effort to coordinate reporting periods across federal programs and the decision to align with the ONC Interoperability and Certification Programs," HIMSS officials said. "With the first MIPS performance full-year reporting period expected to begin on January 1, 2017, we're further analyzing the MACRA rule to ensure that Medicare providers will be able to meet the proposed requirements." American Medical Association President Steven Stack, MD, meanwhile, said it's "hard to overstate the significance of these proposed regulations for patients and physicians." In particular, he was pleased that CMS has been listening to physicians’ concerns and "has made significant improvements, by recasting the EHR meaningful use program and by reducing quality reporting burdens." American Health Information Management Association CEO Lynne Thomas Gordon released a statement saying AHIMA supports the MIPS progam's "emphasis on interoperability, information exchange and security measures, which we believe are critical to reaching the rule’s stated long-term goal of ‘better care, smarter spending, and healthier people.'" The Premier healthcare alliance was less pleased, however – specifically taking issue with one part of the two-pronged MACRA approach to value-based care: its provisions related to advanced payment models, or APMs. CMS "made a significant mistake in not including any bundled payment or Track 1 Medicare Shared Savings Program ACOs as qualifying advanced payment models under MACRA," said Blair Childs, senior vice president of public affairs at Premier Inc. "Rather than rejecting bundled payment programs, we believe CMS should focus on ways to alter the bundled payment programs to demonstrate use of certified EHR technology and align measures with other Advanced APMs. "We also believe CMS seriously erred in excluding Track 1 MSSP ACOs in the APMs for failing to meet the more than 'nominal risk' financial requirement," said Childs. "As we've learned through members in our Population Health Management Collaborative, these programs require providers to not only forego revenue through a lower volume of services, but also investment millions of dollars in redesigning care through new technologies, data analytics, additional staff, etc.," he said. "We think most businessmen would call that more than nominal risk, yet CMS choses to define it as only cases where there is risk to the government." Elsewhere in the Twitterverse, the response was mostly positive – with some skepticism and a bit of I-told-you-so mixed in. And "Meaningful Use" is going "away" by changing its name to "Advancing Care Information" #MACRA #livetweeting as I read the proposed rule — Joy Rios (@askjoyrios) April 28, 2016 or basically what #MU should have been from day 1 @Travis_Broome — Harold Smith III (@haroldsmith3rd) April 28, 2016 1/Bottom Line #MACRA NPRM Game changer. Lots of great changes, 100's of thoughtful details and decisions. Biggest blind spot can be fixed — Farzad Mostashari (@Farzad_MD) April 27, 2016 Really good YouTube "whiteboard" connecting the dots of our MACRA announcement. Plain English. No acronyms. Wow. https://t.co/qLHSpYnWRX — Andy Slavitt (@ASlavitt) April 27, 2016 A tree died for this #MACRA #MIPS #Medicare pic.twitter.com/YsiSd3R9Mf — Amanda Narod (@AmandaBinDC) April 28, 2016

The U.S. Department of Health and Human Services issued a long-awaited proposed rule for the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, on Wednesday, ushering in some big changes for the ways physicians are assessed for quality of care and use of information technology.    

Starting in 2019, Centers for Medicare & Medicaid Services, will change how they pay physicians in a profound way. Unfortunately, the details are complicated and confusing, and many of the particulars have yet to be worked out, which has led many healthcare leaders to glaze over the details and focus on more immediate concerns.

One week after Andy Slavitt said meaningful use would be replaced soon, the acting Centers for Medicare and Medicaid Services administrator and national coordinator Karen DeSalvo made it clear that the changes would take time and that providers must still follow the current program. Slavitt and DeSalvo in a blog post Tuesday afternoon explained the new regulatory framework would move away from measuring clicks to focusing on care. [Also: Meaningful use will likely end in 2016, CMS chief Andy Slavitt says] Two big changes have helped cause this shift from measuring technology adoption levels to looking for quality outcomes, they wrote. First was HHS' ambitious goal, announced about a year ago, that 30 percent of Medicare payments be linked to value-based care in 2016, and 50 percent by 2018. The second was the passage of the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, which holds quality, cost and clinical practice improvements as key factors in determining how Medicare physician payments are doled out. "While MACRA also continues to require that physicians be measured on their meaningful use of certified EHR technology for purposes of determining their Medicare payments," Slavitt and DeSalvo wrote, "it provides a significant opportunity to transition the Medicare EHR Incentive Program for physicians towards the reality of where we want to go next." CMS has been "working side by side with physician and consumer communities and have listened to their needs and concerns," according to CMS and ONC. [Also: CIOs celebrate end to meaningful use] Further details for the proposed rules, along with a public comment period, will be forthcoming "this spring." In the meantime, Slavitt and DeSalvo promised a new set of priorities that reward providers for the outcomes they're able to achieve for their patients with the help of technology. This means they'll be "allowing providers the flexibility to customize health IT to their individual practice needs," they wrote. "Technology must be user-centered and support physicians." They also pledge to help level the playing field to spur innovation, "including for start-ups and new entrants," by focusing on the open APIs so common in consumer technology. "This way, new apps, analytic tools and plug-ins can be easily connected to so that data can be securely accessed and directed where and when it is needed in order to support patient care," according to Slavitt and DeSalvo. And interoperability will continue to be a priority for both agencies, which will continue to drive national interoperability standards that are based in "real-world uses of technology, like ensuring continuity of care during referrals or finding ways for patients to engage in their own care." Slavitt and DeSalvo can be expected to offer more details on these coming changes at HIMSS16 in Las Vegas, Feb 29-March 4. In the meantime, they said physicians and hospitals alike should keep some important things in mind as staged meaningful use is phased out and this new MACRA-based program comes into focus. First, existing law "requires that we continue to measure the meaningful use of ONC Certified Health Information Technology under the existing set of standards. While MACRA provides an opportunity to adjust payment incentives associated with EHR incentives in concert with the principles we outlined here, it does not eliminate it, nor will it instantly eliminate all the tensions of the current system." Second, MACRA "only addresses Medicare physician and clinician payment adjustments." Hospitals have a different set of statutory requirements. "We will continue to explore ways to align with principles we outlined above as much as possible for hospitals and the Medicaid program." [Like Healthcare IT News on Facebook] Third, the changes to meaningful use under MACRA "won’t happen overnight," they write. "Our goal in communicating our principles now is to give everyone time to plan for what's next and to continue to give us input. We encourage you to look for the MACRA regulations this year; in the meantime, our existing regulations – including meaningful use Stage 3 – are still in effect." Fourth, they point to recent legislation that streamlines CMS' process for granting meaningful use hardship exceptions. "This will allow groups of health care providers to apply for a hardship exception instead of each doctor applying individually. This should make the process much simpler for physicians and their practice managers in the future. We will be releasing guidance on this new process soon." In closing, Slavitt and DeSalvo said that "moving from principles to reality" can be challenging.  But ultimately, they write, "we believe this is a process that will be most successful when physicians and innovators can work together directly to create the best tools to care for patients. We look forward to working collaboratively with stakeholders on advancing this change in the months ahead." Twitter: @MikeMiliardHITN