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Slavitt: MACRA Implementation to Be Collaborative, Iterative

MACRA will be "transformative" so long as the entire healthcare industry collaborates and iterates continually, according to the CMS chief.

By Kyle Murphy, PhD

- While CMS intends for MACRA implementation to serve as a continuation of its efforts to shift from volume to value, the federal agency recognizes the need for both collaboration and iteration to ensure that its deployment achieves its goals of patient-centered, provider-driven care.

MACRA implementation

That message was at the heart of comments Acting Administrator Andy Slavitt made earlier this week at the annual members meeting of the American Medical Association (and made available in toto via the federal agency's blog).

"I offer one editorial comment on new payment models," Slavitt said following remarks on the aims of Quality Payment Program. "We should all take a step back and recognize that all of them are at early stages. I compare them to the first and second generation iPhones, still getting their first use and allowing us to see what works and what doesn’t. We should — however — expect these models to get better and better with every release."

Slavitt further elaborated on the work-in-progress state of MACRA implementation as it relates to accountable care organizations, which will fall under the Alternative Payment Model (APM) portion of the recently issued proposed rule.

"We also clearly heard that hospitals want us to fundamentally re-think the benchmarking and rebasing methodologies in our Shared Savings ACO models and we published a proposed rule that reflected a lot of the input we received," he continued. "As they develop, it would be a mistake to view these models as fully calibrated incentives; rather they offer change management opportunities for the changes we all see ahead. Culture and leadership will always drive quality care; our job is to recognize it and reward it and enable investment in it."

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Taking a step back, Slavitt's initial comments on MACRA implementation during the AMA meeting focused on three characteristics the federal agency targeted in developing the proposed MACRA rule:

First, the program is designed to be patient-centric by focusing on quality of care, the total care experience, and care coordination. We have reduced the number of measurements and built a lot of flexibility into the program so that the care measures selected can match the patient need as much as possible.

Next, we structured the program to be practice-driven by allowing physicians to choose their own metrics and the programs — whether the MIPS program introduced by Congress or the Advanced Alternative Payment Models that many clinicians are beginning to have experience with. MIPS is designed to be an attractive option while physicians consider ramping up over time into a variety of more advanced Alternative Payment Models. We also allow physicians who have experience with any ACOs to benefit from their experience.

Third, we have focused on simplicity wherever possible and taken what over time has become a patchwork of quality and other reporting programs and streamlined them into a single framework to reduce the burden on physician offices. Our proposal to replace Meaningful Use in the physician’s office with a new program Advancing Care Information, is an example of where we have responded to considerable feedback to move the focus from “clicking” to care provision and collaboration.

Before closing his remarks, Slavitt called attention to some unfinished business that CMS is working to address in its continued implementation of MACRA as well as the Affordable Care Act (ACA).

First, the federal agency is placing strong emphasis on simplification to reduce reporting burdens for providers that could prevent the latter from spending more important time with their patients:

The work we’ve done recently over the two-midnight policy and the RAC program reflects the result of paying attention to significant feedback and is intended to create more discretion for care providers and move the RAC program from a “gotcha” feeling to a more educational and partner-oriented approach using QIOs. And we are in conversations now about finding opportunities to find ways to extend the simplifications of Advancing Care Information, the successor to Meaningful Use, into the hospital setting.

Second, CMS fully intends to make good on provisions of MACRA with the purpose of assisting providers in rural geographies.

Third and lastly, Slavitt described how a collaborative approach by regulators, providers, and vendors will lead to much-needed advancements in health IT interoperability:

I encourage all of you to become part of our effort by using established standards and adopting contracts with vendors which doesn’t permit charges and other pernicious practices that prevent data from safely moving to where the care of the patient warrants. Together, we have made significant investments in new technology, but they will only be fully realized if Health IT becomes a connected platform for collaboration and innovation. Interoperability is a priority at the very highest levels of government.

While the CMS chief stressed that no single piece of regulation will provide a silver bullet, his comments clearly demonstrate that the federal agency has high hopes for MACRA and its implementation to continue the transition to value-based care.

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