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CMS Issues Proposed Rule Implementing MACRA

by | May 3, 2016 | CMS-nir, Essential, Health care reform-nir, Legislation-nir, National Lab Reporter, Reimbursement-nir

From - National Intelligence Report In January, the Centers for Medicare & Medicaid Services (CMS) Acting Administrator Andy Slavitt indicated the "Meaningful Use program as it has existed, will now… . . . read more

By Kelly A. Briganti, Editorial Director, G2 Intelligence

In January, the Centers for Medicare & Medicaid Services (CMS) Acting Administrator Andy Slavitt indicated the “Meaningful Use program as it has existed, will now be effectively over and replaced with something better.” CMS has now issued a proposed rule providing a look at that something better. “[W]e are proposing to incorporate the [Meaningful Use] program in to 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, 2016. It repealed the sustainable growth rate formula and emphasized the new Merit-Based Incentive Payment System (MIPS) and incentive payments for participation in certain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 final 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.”

MIPS measures value through four performance categories:

  • Quality—physicians must report on six measures
  • Advancing Care Information—providers can select “customizable measures” for reporting their day-to-day use of technology and demonstrate interoperability.
  • 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.”

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.

“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.

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