On April 27, the Centers for Medicare and Medicaid Services (CMS) released its Medicare Access and CHIP Reauthorization Act (MACRA) proposed rule. The proposal contains the guidelines surrounding the monumental piece of legislation that passed in May 2015.
MACRA removes the sustainable growth rate (SGR) formula, more colloquially known as the "doc fix," which cut Medicare payments for services and replaced it with a .5 percent year-over-year increase in the physician fee schedule.
The passage of the Affordable Care Act (ACA) began the shift in Medicare's payments systems to value over volume. The MACRA proposed rule would improve the relevancy and depth of Medicare's quality-based payments and increase clinician flexibility by allowing clinicians to choose measures and activities appropriate to the type of care they provide.
Additionally, the proposal links payments to value via the Merit-based Incentive Payment System (MIPS), in which most Medicare clinicians will initially participate through a Quality Payment Program. Under MIPS, physicians will be measured in four areas:
- Technology use
- Practice improvement
- ACOs in "Track 1" of the Medicare Shared Savings Program won't qualify as an Advanced Alternative Payment Model (APMs).
- CMS outlined three standards that will be used to determine whether providers are assuming more than "nominal" financial risk, a crucial metric for determining eligibility as an Advanced Alternative Payment Model.
- To qualify as an Advanced Alternative Payment Model (APM), providers will have to comply with a number of health IT requirements: 50 percent of clinicians must use certified electronic health records by 2017 and 75 percent by 2018.
- CMS will sunset its meaningful use program - as expected - and replace it with the new Advancing Care Information (ACI) program, which is intended to offer more flexibility.
- MIPS-eligible clinicians will still be on aggressive upgrade timelines for their health IT. By 2018, clinicians will have to use 2015-edition certified products only and will have to perform requirements which "correlate" with meaningful use stage 3.
Deadline to comment: June 27, 2016, by 5 p.m. EDT
A more comprehensive summary will be available in the coming weeks.