Changes could be imminent to the U.S. government's program for shifting healthcare practices toward value-based care and away from volume. The U.S. Centers for Medicare and Medicaid Services (CMS) on June 20 announced a proposed rule that aims to simplify reporting requirements under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.
MACRA was passed in 2015 as part of a compromise that eliminated Medicare's reliance on the flawed sustainable growth rate (SGR) formula. It tried to shift the Medicare system away from fee-for-service medicine and toward payments based on value provided to patients. But the complexity of the effort prompted CMS to delay implementation of MACRA to January 2017; the agency released a final rule for year 1 of MACRA implementation in October 2016.
However, the election of Donald Trump as president has resulted in a sea change in regulation of U.S. business, and healthcare is no exception. In announcing the new proposed rule for year 2 of the program, CMS Administrator Seema Verma noted that the agency's goal is to "simplify the program, especially for small, independent, and rural practices, while ensuring fiscal sustainability and high-quality care within Medicare."
The full proposed rule can be viewed on the CMS website and runs 1,085 pages, but a synopsis is also available. Some of the major plans are as follows:
- Continuing the "virtual groups" program for MACRA participation; the virtual groups program enables solo practitioners and groups with fewer than 10 physicians to participate in the Merit-Based Incentive Payment Systems (MIPS) by coming together with other small practices
- Increasing the low-volume threshold at which small practices and rural clinicians are considered exempt from participation in MIPS
- Allowing use of the 2014 edition of certified electronic health record technology (CEHRT) while encouraging adoption of the 2015 edition of CEHRT
- Within MACRA's scoring methodology, adding bonus points for caring for complex patients or exclusively using the 2015 edition of CEHRT
- Additional flexibility for clinicians in small practices, such as a new hardship exemption, added bonus points for the final score for these clinicians, and three additional points in the quality performance category for measures that don't meet data completeness requirements
The proposed rule also addresses appropriate use criteria (AUC), which CMS is going to require for the ordering of advanced diagnostic imaging services. For the 2018 MIPS reporting period, CMS is proposing adding a new improvement activity that clinicians who are eligible for MIPS can choose if they attest they are using AUC through a "qualified clinical decision-support mechanism" for all advanced imaging services ordered.
The proposed rule also includes revisions to provisions implementing the 21st Century Cures Act regarding electronic record technology and alternative payment models (APMs).
CMS is accepting comments on the proposed rule through August 18. More information is available here.
