CMS releases final rule on MACRA

Healthcare providers in the U.S. are finally getting a definitive road map on how to implement provisions on value-based care in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) after the U.S. Centers for Medicare and Medicaid Services (CMS) released its final rule today.

The U.S. Congress passed MACRA in 2015 with two goals in mind: replacing the flawed sustainable growth rate (SGR) formula, and shifting the U.S. healthcare system's focus away from fee-for-service medicine, which has been blamed for the country's high levels of healthcare spending and poor clinical outcomes relative to other developed nations.

"By implementing MACRA ... we support the nation's progress toward achieving a patient-centered healthcare system that delivers better care, smarter spending, and healthier people and communities," CMS said in an executive summary announcing the final rule.

The CMS guidance covers both the Merit-Based Incentive Payment System (MIPS) and advanced alternative payment models (APMs), which are two avenues of incentives in the Medicare Physician Fee Schedule for getting physicians to move away from fee-for-service healthcare and toward a system based more on quality delivered to patients.

Broadly speaking, MACRA requires healthcare providers to demonstrate that they are tracking the quality of care they deliver to patients as part of a Quality Payment Program. The government is giving providers a number of different tracks toward demonstrating compliance as part of the MIPS and advanced APM programs.

The goal of the advanced APM structure is to enable providers to deliver better healthcare and smarter spending by allowing physicians to deliver coordinated, high-quality care in a streamlined payment system, CMS said. With MIPS, the structure will cover four main areas: quality, clinical practice improvement activities, meaningful use of electronic health records, and resource use.

Physicians will receive either positive or negative adjustments to reimbursement for healthcare services based on their participation in the Quality Payment Program. The 2017 calendar year will be considered a transition year, and 2018 may be a transition year as well as the program is adjusted based on feedback from providers.

The final rule does include some changes from a proposed rule earlier this year. These include bolstering support for small practices, offering new opportunities for advanced APMs, creating a "pick-your-own-pace" approach in the initial years of the program, and connecting different government initiatives such as meaningful use into one unified program.

In a response to the final rule, the American College of Radiology (ACR) noted that CMS had addressed several key elements of the program that pertain to radiologists that had come up when the proposed rule was issued. The ACR is reviewing the final rule and plans to comment on the sections that pertain to radiologists in the days ahead.

The executive summary of the final rule on MACRA can be viewed on the CMS website.