Scott Mace | August 1, 2016
The move from meaningful use to the value-based payment world of MACRA, MIPS, and the APMs is coming into focus.
Meaningful use as we knew it changed on April 14, 2015. And what it’s becoming is still being discerned by physicians, healthcare executives, and the industry at large.
On that date, a large bipartisan majority in Congress passed the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA. MACRA permanently repeals the flawed Sustainable Growth Rate formula for determining Medicare payments for clinicians’ services. According to the Centers for Medicare & Medicaid
Services, it also establishes a new framework for rewarding clinicians for value over volume, and streamlines other existing quality-reporting programs into a single new system.
But before any of that can occur, the entire healthcare industry must gain a better understanding of MACRA, policies and procedures must be implemented, and technology needs a serious upgrade. In January 2016, Acting CMS Administrator Andy Slavitt created some confusion in the industry by describing MACRA as the end of meaningful use as we knew it, when, in fact, later clarifications more accurately described it as an evolution of meaningful use for physicians as expressed by Congress in the MACRA legislation.
The true scope of MACRA became clearer on April 25, 2016, when CMS released the 962-page Notice of Proposed Rulemaking (NPRM) for MACRA, and opened a two-month comment period. As Slavitt had to emphasize in January, the meaningful use program would continue uninterrupted for hospitals. In fact, stage 3 of meaningful use for hospitals, which is also a component of moving toward value-based care, is due to commence in 2017 for early adopters, and in 2018 for hospitals in general.
But on the physician side, as spelled out in the MACRA legislation, meaningful use was indeed being replaced by a program given the new name Advancing Care Information (ACI), which is just one component in the larger matrix of CMS physician incentive programs that kick in January 2017 and that will trigger increased or decreased payment adjustments starting in 2019.
Those incentive programs, known as the Merit-Based Incentive Payment System (MIPS), and Alternative Payment Models (APM) will start to move all physicians toward a goal expressed in the 2010 Affordable Care Act: for physicians to be reimbursed not for services rendered, but instead for outcomes.
How to get from fee-for-service to value-based care is still a journey of many unknown turns for providers, not all of whom are convinced that ACI will do away with the busywork physicians had to perform under meaningful use.
“Based on what I’m seeing so far of MACRA, I think we’re still going to be clicking a lot of boxes” in 2017, says Randy McCleese, vice president of information services and chief information officer at St. Claire Regional Medical Center, a 159-licensed-bed Morehead, Kentucky, hospital with 100 physicians, six primary care clinics, and two specialty clinics.
Like many of his executive counterparts, McCleese, a past board chairman of the College of Healthcare Information Management Executives, spent the weeks following the release of the MACRA NPRM on numerous conference calls, as the industry struggles to make sense of the proposed rule and chart a path forward. “We, as an organization, are just starting to get our hands around MACRA,” he says.
Some of the organization’s physicians believe that MACRA means the end of meaningful use. “The meaningful use program is just being rolled into and consumed into something bigger and something broader,” McCleese says.
McCleese welcomes the consolidation of overlapping quality measures outlined both in meaningful use stage 3 and in the proposed MACRA rule. At present, “we’ve got to report the same thing in three or four different formats to different agencies that need the same data,” he says.
Source: Health Leaders Media
http://www.healthleadersmedia.com/finance/macra-end-meaningful-use-and-beyond