Yesterday, CMS issued a proposed rule to update the Medicare Access and CHIP Reauthorization Act of 2015's second year quality payment program, largely focused on simplifying the reporting process and relaxing requirements.
"We've heard the concerns that too many quality programs, technology requirements and measures get between the doctor and the patient," said CMS Administrator Seema Verma. "That's why we're taking a hard look at reducing burdens. By proposing this rule, we aim to improve Medicare by helping doctors and clinicians concentrate on caring for their patients rather than filling out paperwork."
The MACRA quality payment program has two tracks, including the Merit-based Incentive Payment System and Advanced Alternative Payment Models. Healthcare providers are able to choose which track they participate in. The proposed changes to MIPS include:
1. Giving a virtual group participation option, which would allow solo practitioners or groups of 10 or fewer clinicians that come together virtually to participate in MIPS.
2. Increasing the low-volume threshold, which could allow additional small practices and rural clinicians to participate in MIPS.
3. Allow the use of 2014 certified EHR technology while encouraging 2015 CEHRT.
4. Adding bonus points in the methodology for treating complex patients and using 2015 CEHRT exclusively.
5. Incorporating MIPS improvement into the overall quality performance scoring.
6. Incorporating facility-based scoring for facility-based clinicians.
7. For clinicians in small practices, there would be a new hardship exception under the Advancing Care Information performance category.
8. Clinicians in small practices would receive bonus points to their final score.
9. Small practices would continue to receive three points for measures in the quality performance category that don't meet data completeness requirements.
10. In the 2018 performance period, the proposed change would allow MIPS eligible clinicians to choose whether they attest to using the appropriate use criteria under the 2016 Physician Fee Schedule Final Rule for advanced diagnostic imaging services ordered.
CMS also proposed updates to APMs, including:
11. Extending the revenue-based nominal amount standard through performance year 2020, which gives providers two additional years to meet the financial risk criterion to qualify for APM participation.
12. Slow the increase in the minimum required amount for medical home models.
The American Medical Association issued a statement in support of the proposed changes.
"In proposing these rules, the administration has taken another step to make sure the promise of MACRA — where physicians are rewarded for involvement and for delivering high-quality, high-value care — will be fulfilled," said AMA President David O. Barbe, MD. "Patients and physicians will benefit from the new MACRA approach, as flexibility is vital when implementing a wide-ranging reform."