Feds Release MACRA Proposed Rule, Outline Meaningful Use Overhaul

Federal health officials announced this week details of an initiative to replace the “meaningful use” Electronic Health Record (EHR) Incentive Program as part of the Medicare Access and CHIP Reauthorization Act (MACRA), in a notice of proposed rulemaking. The Centers for Medicare and Medicaid Services (CMS) announced in January that it would be phasing meaningful use out by the end of the 2016, and adopt a program that instead incentivizes physicians participating in alternative payment models.

According to a blog post written by Andy Slavitt, CMS acting administrator, and Karen DeSalvo, MD, MPH, MSc , national coordinator of the Office of the National Coordinator for Health IT (ONC), both agencies completed a comprehensive review of meaningful use as part of the MACRA implementation. Based on that review, CMS and ONC have decided to transition meaningful use into the Merit-based Incentive Payment System (MIPS). The new EHR initiative, under MIPS, will be known as Advancing Care Information. The new law only affects Medicare payments to physician offices—not Medicare hospitals or Medicaid.

The transition to the Advancing Care Information designation, wrote Slavitt and DeSalvo, prioritizes:

  • Improved interoperability and the ability of physicians and patients to easily move and receive information from other physicians’ systems
  • Increased flexibility in the meaningful use program
  • User-friendly technology designed around how physicians work and interact with patients

Slavitt and DeSalvo outlined some differences between Advancing Care Information and meaningful use by noting that the former would:

  • Allow physicians and other clinicians to choose to select the measures that reflect how technology best suits their day-to-day practice
  • Align with the Office of the National Coordinator for Health IT’s 2015 Edition Health IT Certification Criteria
  • Emphasize interoperability, information exchange, and security measures and require the ability for patients to access their health information through application program interfaces (APIs)
  • Simplify reporting by no longer requiring all-or-nothing EHR measurement or quality reporting
  • Reduce the number of measures to an all-time low of 11 measures, down from 18 measures, and no longer require reporting on the Clinical Decision Support and the Computerized Provider Order Entry measure
  • Exempt certain physicians from reporting when EHR technology is less applicable to their practice and allow physicians to report as a group

The new rule will be published in the Federal Register on May 9, and will welcome public comment for 60 days. If the law is finalized, it will go into effect January 1, 2017.

“The American Health Information Management Association is encouraged to see that the proposed rule to implement provisions of the Medicare Access and CHIP Reauthorization Act (MACRA) includes ‘advancing care information’ as one of the components of the Merit-based Incentive Payment System (MIPS),” said AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA. “We support its emphasis on interoperability, information exchange, and security measures, which we believe are critical to reaching the rule’s stated long-term goal of ‘better care, smarter spending, and healthier people.’ AHIMA will continue to analyze the proposed rule and work with its members to provide comments.”

In addition to the health IT impacts of MACRA, it also makes broad changes to how physicians are paid. As the rule states, “MACRA repeals the Medicare sustainable growth rate (SGR) methodology for updates to the physician fee schedule and replaces it with MIPS, for MIPS-eligible clinicians or groups under the physician fee schedule (PFS).”

In making this change the rule provides more clarity about its three existing payment models, the Physician Quality Reporting System, the Physician Value-based Payment Modifier, and meaningful use. MACRA also contains provisions around telehealth. It requires the Government Accountability Office to produce two telehealth-related reports. The first report will “evaluate circumstances that help or inhibit the use of telehealth under Medicare, and the possible effects of an expansion of telehealth on payment and delivery systems under Medicare and Medicaid.” The second report will “examine incentives for adopting patient monitoring technology and services by private health insurance, as well as barriers for adopting this technology by Medicare,” according to an article in Health Law & Policy Matters.

Click here to read the full text of the proposed rule.

Click here for more details on how physicians are paid by MIPS.

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