CMS Releases MACRA Final Rule

The Centers for Medicare and Medicaid Services (CMS) released its hotly anticipated 2,400-page Medicare Access and CHIP Reauthorization Act (MACRA) Final Rule on Friday. The rule, now open for comment, finalizes the new payment and healthcare quality reforms for those physicians seeking reimbursement for services by Medicare.

“The policy released today is the first step in a multi-year journey in which we are particularly focused on allowing clinicians to transition at their own pace, continuing to get feedback from the field, providing meaningful support, and improving the program over time,” wrote CMS Acting Administrator Andy Slavitt in a blog post Friday announcing the final rule’s release.

While CMS claims MACRA will better reward providers for quality patient care and eventually lower costs, some physicians have expressed concern that the changes in payment enacted by the rule could put them out of independent business.

MACRA received strong bipartisan support in Congress as it repealed the Sustainable Growth Rate (SGR) payment formula that increasingly reduced Medicare payments to clinicians. It was signed into law by President Obama in April 2015. However, MACRA also replaced the SGR with MIPS and Advanced APMs, which serve as an alternative to MIPS.

Eligible clinicians impacted by MIPS and Advanced APMs include physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists. The impact on health information management professionals—better healthcare documentation and information governance will likely be needed in order to comply with MACRA, since providers will need to prove through their health records that services were not just rendered but actually lead to quality care.

The final rule addresses concerns expressed by smaller physician practices about the flexibility of participation in Merit-based Incentive Payment Programs (MIPS) and Advanced Alternative Payment Models (APMs), the two primary programs included in MACRA for shifting physicians from a fee-for-service payment model to a quality-centric payment model. To avoid penalties, physician practices must choose to participate in the MIPS program or the APM.

According to Slavitt’s blog post, “Other than a 0.5 percent fee schedule update in 2017 and 2018, there are very few changes when the program first begins in 2017. If you already participate in an advanced APM, your participation stays the same. If you aren’t in an advanced APM, but are interested, more options are becoming available. If you participate in the standard Medicare quality reporting and Electronic Health Records (EHR) Incentive Programs, you will find MIPS simpler. And, if you see Medicare patients, but have never participated in a Medicare quality program, there are paths to choose from to get started. The first couple of years are aimed at getting physicians gradually more experienced with the program and vendors more capable of supporting physicians. We have finalized this policy with a comment period so that we can continue to improve the program based on your feedback.”

CMS also is rolling out a new Quality Payment Program website that will explain the new program and help clinicians easily identify the measures and activities most meaningful to their practice or specialty.

According to Slavitt, CMS gathered input for the final rule via a “listening tour” involving 100,000 stakeholders and received 4,000 comments on the draft rule. The rule changes go into effect on January 1, 2017.

Click here to read Slavitt’s blog post, and here to visit the Quality Reporting website. Click here to read the Department of Health and Human Service’s press release on the MACRA Final Rule, and click here for fact sheets on all of the new programs. Background on the MACRA proposed rule’s impact on HIM can be found here.

Visit the Journal of AHIMA website in the coming weeks for full analysis of the final rule and its direct impact on health information management professionals.

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