Key issues to watch in the MACRA Proposed Rule

The MACRA Proposed Rule details CMS’ new payment approach, which emphasizes and rewards the use of interoperable health information technology by physicians and other Medicare Part B clinicians and that steers clinicians toward alternative payment models.  The Proposed Rule would establish key parameters for the new Quality Payment Program, a framework that includes the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). These policies were established by the latest, permanent ‘doc fix,’ that Congress passed in 2015.

MIPS and APMs

The bad news: more acronyms to remember.  The good news: CMS seems to be making a concerted effort to simplify the current quality reporting requirements for physicians.  MIPS will consolidate three current CMS programs: Physician Quality Reporting System, the Value-Based Modifier Program, and Meaningful Use of EHRs.  MIPS will score physician on four performance categories: Quality, Resource Use, Clinical Practice Improvement Activities, and Advancing Care Information (f/k/a Meaningful Use). Most physicians will report through MIPS in the first year of the program, which will be 2019. The MIPS bonus or penalty is proposed to start at 4% and moves successively up to 9% by 2022.

APMs will initially include advanced ACOs (such as the Next Gen model), Patient Centered Medical Homes (Medical Homes), the new Comprehensive Primary Care Plus (CPC+), and some other bundled payment programs.  APM program will award qualifying physicians a fixed, annual bonus of 5% of their reimbursement from 2019 to 2024, with the opportunity to earn more if they meet savings targets.  However, a benefit to qualifying under APM rather than the MIPS is that clinicians do not need to report any data under MIPS measures.

Key Issues to Watch

As with any proposed rule that seeks to fundamentally shift how physicians are paid by Medicare, there are both supporters and critics. Below are a few key issues that we’re watching as CMS moves to issue the final MACRA rule in the fall of 2016.

• Measurement Starts in 2017! The clock is ticking. Physician performance will start to be measured in 2017 for purposes of determining incentive payments in 2019.  Some physician organizations, including the American Academy of Family Physicians, are advocating for these measurements to start in 2018.

• Greater Risk Sharing, More Consolidation. Preparing and complying with MACRA will be a difficult and expensive task, which may cause an uptick in physicians joining or affiliating with health systems.

• Benefits for Early “Medical Home” Adopters. Certified Patient Centered Medical Homes automatically qualify for the highest possible score for the practice improvement component of MIPS program (15% of their total score), and can also can qualify as an APM without having to take direct financial risk.

• EHR Interoperability. CMS and ONC officials have indicated that MACRA will help transition physicians from a system of simply measuring use of EHR systems into a system that rewards providers that use technology to better patient outcomes, to promote innovation “by unlocking electronic health information through open APIs – technology tools that underpin many consumer applications,” and by prioritizing EHR interoperability.  CMS desire is for all patient data to be connected across the spectrum of care, whether home, ambulatory, acute or post-acute.  The goal is for every health device to be able to “plug-and-play” off a single interoperable platform.

Keep checking back to the Health Law Checkup for MACRA developments and analysis of CMS final MACRA rule, which is anticipated this fall.