CMS Releases Final MACRA Rule

The Centers for Medicare and Medicaid Services (CMS) recently announced its final MACRA rule on the physician quality payment program, in an effort to create a more modern, patient-centered Medicare program.

“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,” Andy Slavitt, acting administrator at CMS, said in a press release. “As we read your comments, engaged directly with many of you, sought guidance from Congress, and considered all the options, we identified these priorities for the design of the program.”

After reviewing patient and clinician feedback, CMS developed the final rule to move away from paying for volume to paying for value, and to improve care and outcomes through efficient utilization of resources.

Upon the program’s launch in 2017, Mr Slavitt expects most of the current advanced alternative payment model (advanced APM) participants to plateau, and remain consistent with their current plan. For non-Medicare patients who are interested in the Medicare quality program, there will be available paths to start with. The goal of the first few years of the new program are aimed at gradually getting physicians more experienced with the program and vendors more capable of supporting the physicians.

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Additionally, CMS plans to offer extended options that fit the diversity of practices and care across the nation while maintaining robust models that actively encourage high-value care for physicians who are interested in participating in advanced APMs.

The CMS intends to explore a new advanced APM in 2018,  the ACO Track 1+, which has lower levels of risk than other Accountable Care Organizations (ACO). Slavitt said, “With these new advanced APMs, we estimate that about 25[%] of eligible Medicare clinicians could be in an advanced APM by the second year of the program.”

CMS introduced steps to aid small practices small practices that deliver the same high-quality care as larger ones, including:

• reducing the time and cost to participate;
• excluding small practices, an estimated 380,000 clinicians;
• increasing the availability of advanced APMs to small practices;
• allowing practices to begin participation at their own pace;
• changing one of the qualifications for participation in Advanced APMs to be practice-based as an alternative to total cost-based; and,
• conducting significant technical support and outreach to small practices using $20 million a year over the next five years, as well as through the Transforming Clinical Practice Initiative. 

CMS expects small practice physicians to have the same level of participation as all other participants.

Another part of the final MACRA rule includes simplifying scoring in the Merit-Based Incentive Payment System (MIPS). CMS will simplify the quality measures and practice-specific improvement activities as well as, align the measurement of certified HER technology with improvement activities.

“Through this process and the input you have given us, CMS is becoming even more open, transparent, and responsive,” Slavitt said to participating physicians. “We are committed to paying close attention to the impact of our policies on care delivery and adjusting along the way. By working together, we can all make real progress in improving the delivery of care in our country.”

—Julie Gould 

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