On April 27, 2016, the Department of Health and Human Services (HHS) released the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) notice of proposed rulemaking (NPRM).
The MACRA proposed rule presents a flexible program rather than one size fits all in an attempt to reduce reporting burden and improve how measure performance supports clinicians enabling them to focus more on the care of their patients.
According to HHS, the primary aim is to simplify and streamline the existing patchwork of value-based payment models that have increasingly replaced the traditional fee-for-service system via a new framework dubbed the Quality Payment Program. The two paths for compliance are the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs). While both programs branch off of what we’ve learned with Meaningful Use, PQRS and quality measure reporting, Meaningful Use measures and clinical quality measures prevail in the four performance categories defined in the MIPS program.
Some highlights from the proposed rule:
- Applies only to eligible Medicare clinicians
- The rule builds on the 2015 Editions EHR Certification criteria
- MIPS has 4 performance categories
- Advancing Care Information (ACI) – Meaningful Use measures
- Quality – PQRS, CQMs
- Clinical Practice Improvement Activities (CPIA)
- Cost/Resource Use
- MIPS is budget neutral, clinicians’ MIPS scores would be used to compute positive, negative or neutral adjustments
- MIPS clinicians are scored on their participation in the four performance categories
- APM requires participation in a qualified program like CPC+ or Medicare Shared Savings program
- APM uses quality measures comparable to measures under MIPS
- 5% annual lump sum bonus potential for APM qualifying providers
- the rule builds on the 2015 Edition EHR Certification criteria
- MIPS and APM performance measuring proposed to begin in 2017
Andy Slavitt, Acting Administrator, Centers for Medicare & Medicaid Services and Dr. Karen DeSalvo, National Coordinator, Office of the National Coordinator for Health IT wrote, “Our goal with Advancing Care Information is to support the vision of a simpler, more connected, less burdensome technology. Compared to the existing Medicare Meaningful Use program for physicians, the new approach increases flexibility, reduce burden, and improves patient outcomes.”
