Stakeholders mixed on MACRA, ONC direct review rules

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Healthcare stakeholders have registered mixed reactions to both the Centers for Medicare & Medicaid Services’ final rule laying out the Medicare Access and CHIP Reauthorization Act of 2015 and the Office of the National Coordinator for Health IT’s final rule on direct review of certified health technology, published Oct. 14.

MACRA feedback

For the former, the College of Healthcare Information Management Executives Vice President for Federal Affairs Mari Savickis lauded CMS for giving doctors the option of a 90-day reporting period for adopting health IT. She also praised the agency for cutting the total number of measures that physicians must report, from 11 in the proposed rule down to five.

CHIME seemed less than pleased with CMS for maintaining that hospitals and clinicians must attest that they are not engaging in information blocking. However, Savickis approved of language that clarified that providers “should not be held responsible for adherence to health IT certification standards” beyond their control.

American Medical Informatics Association President and CEO Douglas Fridsma called CMS’ policies “strategic, flexible and reflective of feedback” from informatics professionals, adding that the agency “created a framework” that enables replacement of the current, outdated fee-for-service payment system.

Meanwhile, Premier Inc., the large group purchasing organization, praised CMS for expanding the alternative payment models (APM) to include Pioneer accountable care organizations, but remained concerned about the amount of payments that are at risk for MACRA participants, up to 9 percent for those engaged in the MIPS model and around 5 percent for APMs.

“Although CMS eased the policy defining the Advanced APM to allow additional programs to qualify and has signaled it will increase the number of available models, the nominal risk standard remains way too high,” Blair Childs, a Premier senior vice president, said in a statement. “As we have learned from members in our bundled payment and population health management collaboratives, these models require significant investment in redesigning care through new technologies, data analytics and additional staff. CMS has chosen to ignore these realities. We call on CMS to rethink this risk standard in future rules to incent greater participation.”

And the American Hospital Association said it was not happy that CMS kept the fairly narrow guidelines for APMs in place, although it expressed some optimism that may change in the future.

“While we are disappointed that CMS continues to narrowly define advanced [APMs], which means that less than 10 percent of clinicians will be rewarded for their care transformation efforts, we are encouraged that CMS is exploring a new option that would expand the available advanced APMs that qualify for incentives,” AHA Executive Vice President Tom Nickels said in a statement.

ONC rule reactions

Both CHIME’s Savickis and AMIA’s Fridsma also praised ONC’s final rule clarifying the agency’s ability to directly review certified health IT and hold developers accountable for non-conformity. Savickis said that hospitals and clinicians “must have confidence” in the products that they purchase, while Fridsma called the rule a “sensible process through which known and potential harms to patient safety can be identified and corrected.”

Health IT Now, however, expressed disappointment in the rule, saying that ONC is “clearly overstepping its statutory authority” through the direct review process. It urged Congress to keep the rule from being implemented.

“By focusing on safety issues, ONC is encroaching on the regulatory functions of other federal agencies like the FDA,” Health IT Now said.