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HHS Releases Finalized Quality Payment Program, MACRA Rule

CMS has released the finalized rule for the Quality Payment Program and MACRA, creating administrative simplification for eligible clinicians.

By Sara Heath

- The Department of Health and Human Services has officially released the final rule for the Quality Payment Program under the Medicare Access and CHIP Reauthorization Act (MACRA), according to a press release.


The Quality Payment Program, which will begin on January 1, 2017, replaces the sustainable growth rate and will reportedly allow providers to deliver more flexible, patient-centered care.

“Today, we’re proud to put into action Congress’s bipartisan vision of a Medicare program that rewards clinicians for delivering quality care to their patients,” said HHS Secretary Sylvia M. Burwell in a public statement.

“Designed with input from thousands of clinicians and patients across the country, the new Quality Payment Program will strengthen our health care system for patients, clinicians and the American taxpayer.”

According to HHS, MACRA and the Quality Payment Program will help drive the industry away from a volume-based system to value-based care models.

READ MORE: AAFP Recommends CMS Simplify MACRA Implementation Requirements

READ MORE: Alpha II Registry Approved as 2017 MIPS Qualified Registry

READ MORE: AMA Leads Call for Addressing EHR Quality Reporting Programs

The Quality Payment Program will reward providers for value-based care via two avenues: Advanced Alternative Payment Models (Advanced APMs) and the Merit-based Incentive Payment System (MIPS).

“Alternative Payment Models are payment approaches, developed in partnership with the clinician community, that provide added incentives to deliver high-quality and cost-efficient care,” says an executive summary of the rule. “APMs can apply to a specific clinical condition, a care episode, or a population.”

MIPS will streamline three pre-existing programs including meaningful use, the Physician Quality Reporting System (PQRS), and the Physician Value-based Payment Modifier System.

It will also “continue the focus on quality, cost, and use of certified EHR technology (CEHRT) in a cohesive program that avoids redundancies,” the rule summary explains.

“It’s time to modernize the Medicare physician payment system to be more streamlined and effective at supporting high-quality patient care. To be successful, we must put patients and clinicians at the center of the Quality Payment Program,” said CMS Acting Administrator Andy Slavitt.

The Quality Payment Program is designed to help eligible clinicians ease into the program at their own pace, helping to integrate them into the evolving healthcare system.

“A critical feature of the program will be implementing these changes at a pace and with options that clinicians choose,” Slavitt said. “Today’s policies are designed to get all eligible clinicians to participate in the program, so they are set up for successful care delivery as the program matures.”

CMS will be accepting public comments on the final rule for the following 60 days after today’s publication.

UPDATE: Industry groups are beginning to issue reactions to the release of the final rule.

Following the publication of the MACRA final rule, the American Medical Association issued a statement from AMA President Andrew W. Gurman, MD.

The AMA acknowledges the commitment by Acting Administrator Andrew Slavitt and his senior team at CMS for listening to physician concerns and taking several concrete steps to help them adjust to this new Medicare payment framework. By announcing the ‘Pick Your Pace’ approach to give physicians greater flexibility and increased options for participating in MACRA in 2017, HHS Secretary Burwell and Acting Administrator Slavitt took a significant step last month to address AMA concerns about the original proposal. The final rule includes additional steps to help small and rural practices by raising the low volume threshold exemption, and practices of all sizes will benefit from reduced MIPS reporting requirements.

AMA says that an initiative review of the law indicates that HHS and CMS has taken into account several AMA suggestions, helping to improve the law for participating clinicians. Going forward, the group plans to conduct a comprehensive review of the rule, taking a closer look at its ability to promote flexibility and innovation in patient care.

American Medical Informatics Association President Douglas B. Fridsma, MD, PhD, FACP, FACMI, also issued a statement, commending the administration's efforts to create a program serving the needs of all providers.

CMS has crafted a set of policies that are strategic, flexible and reflective of feedback from the informatics community. AMIA recommended that CMS provide physicians with an on-ramp to participation in 2017 and they have responded with a strategy that will do just that. Beginning with a much-needed “transition year” for participation, and inclusive of an across-the-board reduction in scope, this final rule with comment period will ensure that success is within reach of every eligible clinician.

AMIA and others in the clinical and informatics community have long-encouraged policymakers to deem certain uses of health IT as being equal to participating in meaningful use, now referred to as Advancing Care Information performance category. Through the open comment period that joins this final rule, CMS asks how to establish such deeming policies with identification of “use cases” that are practice-based activities for which CEHRT is used in a typical clinician workflow.

While there are hundreds of individual policies that need to be considered in this final rule, we believe CMS has created a framework through which we can finally address our outdated fee-for-service payment system, and replace it with a modern patient-focused system based on outcomes.

Mari Savickis, Vice President for Federal Affairs of the College of Healthcare Information Management Executives, released a statement saying that CMS has made several steps forward in offering reporting options for providers.

"While we are still reviewing the 2,400-page rule, the Centers for Medicare and Medicaid Services today seemed to take important steps in giving physicians much-needed flexibility for adopting health information technology as they transition to a new payment model," Savickis said in a public statement.

"Unfortunately, CMS appears to have retained stringent language requiring hospitals and clinicians to attest that they are not engaging in information blocking," Savickis continued. "The agency does, however, clarify that providers, 'should not be held responsible for adherence to health IT certification standards or other technical details of health IT implementation that are beyond their expertise or control.'"

The American College of Rheumatology praised the new rule, stating that its provisions will help small and rural rheumatology practices succeed in the program.

“While we have not had time to review the final rule in its entirety, we are encouraged to see that the Centers for Medicare and Medicaid Services (CMS) is listening to the concerns raised by the American College of Rheumatology (ACR) regarding the need for reporting requirements that are simple, transparent, and tenable – especially for small and rural rheumatology practices," the group wrote in a public response.

ACR also praised CMS for granting providers multiple reporting options, allowing for flexibility that will smooth the transition from one federal program to the next.

Like the AMA, ACR has plans to continually assess the final rule.

“The ACR’s policy and legislative staff are closely examining the rule to determine whether some of the other key concerns raised by the rheumatology community – such as the inherent problems with the Resource Use category of MIPS, and the formidable barriers that exclude many rheumatologists from participating in the Alternative Payment Model (APM) track – have been sufficiently addressed," ACR stated.

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