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MACRA final rule met with guarded, but mostly positive reaction

The MACRA final rule eases ways for doctors to measure patient care data for Medicare reimbursement; meanwhile, ONC focused its authority on patient safety in health IT systems.

The MACRA final rule relaxes some health data collection and reporting requirements for physicians in 2017, while new health IT certification rules focus on government oversight of EHR vendors on patient safety problems.

The Department of Health and Human Services' release of the MACRA final rule on Oct. 14 came more than a year after Congress overwhelmingly passed the new healthcare law and after much concern in the medical community about its potentially burdensome requirements.

The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, establishes a Quality Payment Program that moves Medicare reimbursement from fee for service to rewards for better medical outcomes.

If they decide not to participate in MACRA's Merit-based Incentive System (MIPS) track, physicians can choose the track of "advanced alternative payment models," such as accountable care organizations (ACOs) and patient-centered medical homes, under which doctors take on financial risk, but also can bear financial rewards.

"Today's rule really marks a shift from when government regulations stopped being the defining element of technology roadmaps and customer needs began to take over," Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services, said during a media conference call.

"The feedback from physicians is clear and is, I believe, directed both at the government and at the tech community," Slavitt said. "Make it easier to practice high-quality care and allow me to spend time with my patients, not on reporting paperwork or using technology that doesn't support my needs."

MACRA will also replace meaningful use for physicians, though the MACRA final rule incorporates some meaningful-use measures, such as "advancing care information." Hospitals are still under the meaningful-use program.

Meanwhile, the Office of the National Coordinator for Health Information Technology (ONC) issued its own final rule for the 2015 edition of health IT certification criteria that appears to narrow and strengthen ONC's authority over EHR safety issues.

Reaction to the MACRA final rule was mostly positive among health system CIOs, physicians and vendors, who welcomed a 90-day reporting option, rather than a full year; the reduction of 11 quality-reporting measures to five, plus one outcome measure; and more exemptions for small physician practices.

"I think the big difference really between the proposed rule and the final rule is 2017 being declared a transition year," John Squire, president and COO of ambulatory EHR vendor Amazing Charts LLC, based in Warwick, R.I., told SearchHealthIT.

Squire also said most Amazing Charts customers are smaller practices that can likely take advantage of the MACRA final rule's exclusions and opt out of MIPS if they do less than $30,000 in Medicare business. Under the proposed rule, the threshold had been $10,000.

Meanwhile, many larger practices already are affiliated with ACOs or other alternative payment models, Squire noted.

In any case, MACRA's new incentive and penalty system for physicians is still set to take effect in 2019. So far, no requirements have been loosened after 2017.

While MACRA's reimbursement rules and  alternative payment models apply only to physicians and practices, the MACRA final rule affects hospitals in a significant, but perhaps somewhat overlooked way, said Mari Savickis, vice president for federal affairs for the College of Healthcare Information Management Executives, or CHIME, based in Ann Arbor, Mich.

Savickis noted the MACRA final rule also includes a ban on the alleged practice of information blocking, which applies to hospitals as well.

The information blocking language was softened, though, to reflect that "healthcare providers should not be held responsible for adherence to health IT certification standards or other technical details of health IT implementation that are beyond their expertise or control," Savickis pointed out.

As for the reduction in the number of reporting measures, some of them are still among the most "aggressive," such as one that requires doctors to show how they can electronically exchange summaries of patient care with other providers.

"The doctor who is sending that summary of care has to make sure that the other provider accepts it into his EHR," Savickis said. "There are still ongoing issues with interoperability."

As for the final certification rule, Vindell  Washington, M.D., national coordinator for health IT, said in a conference call with reporters that ONC will take on more direct responsibility for ensuring health IT systems are safe, rather than relying solely on its authorized third-party certification bodies.

"From that perspective, it's helpful," Savickis said. "We're pleased to see that they've narrowed down their direct review to safety-related issues."

Next Steps

Analytics helps providers navigate MACRA

APIs now required in 2015 edition of certified health IT

Many hospitals not ready for alternative payment models, according to report

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