CMS Releases 2018 MACRA Draft Rule

The Centers for Medicare and Medicaid Services (CMS) has responded to stakeholder concerns about the burdens of complying with multiple quality programs and competing deadlines by easing some MACRA requirements in the 2018 proposed MACRA rule, which was released this week. MACRA, the Medicare Access and CHIP Reauthorization Act, is the 2015 law that replaced the Medicare sustainable growth rate (SGR) formula.

“It is clear that CMS has listened to the various stakeholder communities and is trying to build in additional flexibility into the program to help providers continue to transition into the Quality Payment Program,” said Lauren Riplinger, JD, AHIMA’s senior director of federal relations. “I would also say that the proposed rule puts specific emphasis on creating additional flexibility for smaller practices that have perhaps struggled with some of the program requirements so far.”

The proposed rule carries out the 2015 law that seeks to overhaul the payment of doctors, and focuses on tying reimbursement to quality measures. The proposed rule provides for additional flexibilities as providers continue to transition into the Quality Payment Program, including:

  • Implementation of virtual groups for small practices
  • The option to use electronic health record (EHR) technology certified to the 2014 Edition for the 2018 performance period
  • Additional pathways in submitting the measures and activities associated with the performance categories

“While we continue to recommend that physicians and clinicians migrate to the implementation and use of EHR technology certified to the 2015 Edition so they may take advantage of improved functionalities, including care coordination and technical advancements such as application programming interfaces, or APIs, we recognize that some practices may have challenges in adopting new certified health IT,” the rule states.

AHIMA specifically applauded this relaxation of requirements. “From the initial rollout of MACRA, our members have expressed concerns that their EHRs and related infrastructure would not be sufficiently prepared to meet the requirements of the Quality Payment Program,” said AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA. “We are pleased that CMS has listened to interested stakeholders and has proposed to make the 2015 EHR Edition optional in 2018.”

The 2018 proposed rule also allows physician offices with under $90,000 in Medicare revenue, or fewer than 200 unique Medicare patients per year, to be exempt from the law.

“Between this year’s exemption and the proposed one for next year, the move will exclude a total of about 834,000 more clinicians from complying with the quality reporting program under the Medicare Access and CHIP Reauthorization Act of 2015. The original threshold was $30,000 or fewer than 100 Medicare patients,” Modern Healthcare reported.

Mary Butler is the associate editor at The Journal of AHIMA.

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