- In light of the recent notice of proposed rulemaking to implement the Medicare Access and CHIP Reauthorization Act (MACRA), several healthcare industry groups have come forward to voice their opinions on ending meaningful use, reducing clinical quality measures, and new value-based reimbursement models.
Under the proposed rule, several CMS programs have been eliminated, including meaningful use, the Physician Quality Reporting System, and the Value Modifier program. CMS intends to replace these programs with value-based systems that are more flexible and less troublesome for Medicare physicians.
While the majority of industry groups have expressed support of CMS’s goals, most healthcare organizations are hesitant to wholeheartedly back the proposed rule.
According to the American Hospital Association (AHA) the proposed role is too narrow despite CMS’s efforts to refocus value-based reimbursement programs to align with hospital and provider needs.
As many value-based programs are ending, the proposed rule is replacing them with the Quality Payment Program, which offers physicians two options for reimbursement. Through the new system, physicians can choose an Alternative Payment Model or the Merit-Based Incentive Payment System (MIPS).
The American Hospital Association stated that the consolidation of value-based payment systems may hinder healthcare innovation at hospitals.
“We are disappointed by CMS’s narrow definition of alternative payment models, which could have a chilling effect on providers’ ability to experiment with new patient-centered, value-driven payment models,” explained Tom Nickels, AHA Executive Vice President, in an official statement. “Today’s rule fails to recognize the significant resources and risk assumed by the highly motivated, early adopters of alternative payment models.”
AHA also commended CMS for decreasing the number of quality measures, but the group still encourages it to modify performance assessments. In particular, AHA recommended that CMS work to “promote collaboration by developing hospital-based physician measure reporting options.”
Several other healthcare industry groups, such as the American Medical Association (AMA) and the American Medical Informatics Association (AMIA), have also applauded CMS for reducing clinical quality measures as well as ending the all-or-nothing approach to meaningful use.
According to AMA, the recent ruling demonstrated that CMS has been working with physicians to understand the burdens of meaningful use and quality reporting. Moving forward, AMA suggested that new quality and health IT programs are assessed with more relevant measures and less stringent reporting requirements.
“Our initial review suggests that CMS has been listening to physicians’ concerns,” said Steven J. Stack, MD, AMA President, in a press release on the AMA website. “In particular, it appears that CMS has made significant improvements by recasting the EHR Meaningful Use program and by reducing quality reporting burdens.”
“The existing Medicare pay-for-performance programs are burdensome, meaningless and punitive. The new incentive system needs to be relevant to the real-world practice of medicine and establish meaningful links between payments and the quality of patient care, while reducing red tape.”
Additionally, AMIA has expressed its approval of specific aspects of MACRA proposals, such as new quality reporting requirements, which would encourage healthcare providers to use quality assessments to improve quality care in their facilities.
“While there is a tremendous amount of detail yet to understand, AMIA applauds CMS proposals that address the ‘all or nothing’ and threshold legacies of Meaningful Use,” stated Jeffery Smith, MPP, AMIA Vice President of Public Policy. “We also support the proposals that refocus requirements on those aspects of the program that are important, such as patient data access and patient engagement, care coordination and health information exchange. These changes will enable all stakeholders – providers and policymakers – to leverage program participation as a means to learn rather than simply grade.”
AMIA also commented on how changes to clinical quality reporting under the proposed rule may help providers use certified EHR systems to advance value-based care.
“We are also encouraged by CMS’s proposals to use the clinical performance improvement activities (CPIA) to enhance the use of certified EHR technology,” continued Smith. “We firmly believe that to be successful in MIPS and APMs a new generation of workforce skills and education will be needed, and we see CPIA options that encourage physicians, and other clinicians, to leverage informatics tools to improve practice as a step in the right direction.”
In addition to AMIA, the College of Healthcare Information Management Executives (CHIME) has commented on how the proposed rule could shift how healthcare providers implement EHR systems and interoperability strategies.
“CHIME has long supported the goals of the federal Meaningful Use program to advance health IT solutions that increase efficiency and improve patient care,” said Russell Branzell, CHIME President and CEO. “While the proposed regulations are largely focused on physicians, there are elements concerning data blocking that apply to hospitals and will be of significant interest to our members.”
The proposed rule presents a monumental turn for physicians in terms of value-based care and reimbursement. While the many healthcare groups have expressed support for specific aspects of the rule, the majority have also reported their intentions to continue pushing CMS to improve quality care and EHR reporting.