CMS unveils MACRA proposal; 'Advancing Care Information' to replace MU for Medicare EPs


The Centers for Medicare & Medicaid Services' new proposed rule implementing the Medicare Access and CHIP Reauthorization Act, as it pertains to the use of electronic health records, varies considerably from physicians' requirements in the Medicare Meaningful Use program, allowing for streamlined reporting, reduced burdens and more flexibility.  

The rule, issued April 27, and slated to be published in the Federal Register May 9, creates a "Quality Payment Program" to replace the old reporting programs, including the Medicare Meaningful Use Program. The new program includes both the Merit Based Incentive Payment System (MIPS) and advanced alternative payment models, explained CMS Acting Administrator Andy Slavitt on a conference call. 

Under MIPS, eligible professionals will be measured on quality, resource use, clinical practice improvements and meaningful use of certified EHR technology. Slavitt pointed out that the new rule is more "patient centered, practice driven and enhances connectivity."  

In a related blog post, Slavitt and National Coordinator for Health IT Karen DeSalvo explained that they reviewed the Meaningful Use program as part of MACRA "with the aim of reconsidering the program so we could move closer to achieving the full potential health IT offers." In the new approach, dubbed Advancing Care Information:

  • Physicians will be allowed to select the measures that reflect how they use EHR technology and what suits their practices.
  • CMS will no longer require all-or-nothing EHR measurement or quality reporting. EPs would receive a base score of 50 percent for reporting on their use of EHR technology, and can earn another 50 percent based on their performance; they also can receive a bonus for reporting to more than one registry.
  • The number of measures will be reduced from 18 to a new all-time low of 11.
  • Reporting of clinical decision support and computerized physician order entry will no longer be required.
  • EPs only have to report to a single public health immunization registry.
  • Some physicians will be exempt from reporting when EHR technology is less applicable.

The rule also emphasizes interoperability, information exchange and security measures and requires patients to have access to their health information through of APIs.

The program would align with the Office of the National Coordinator for Health IT's 2015 certification criteria, meaning developers should continue on that pathway, including transparency and data sharing, DeSalvo said on the call. 

These changes only apply to EPs in the Medicare Meaningful Use program, who will be transitioning out from that program. However, penalties for Meaningful Use for Medicare clinicians won't end until the end of 2018 (for performance year 2016), according to Kate Goodrich, director of CMS' Center for Clinical Standards and Quality, who also spoke on the call. The proposed rules will not impact EPs in the Medicaid program or hospitals. 

MACRA requires the rule implementing MIPS be published by Nov. 1, 2016. It will be effective Jan. 1, 2017.

To learn more:
- read the rule (.pdf)
- here's the fact sheet
- read the blog post