Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

Considering MACRA’s Effect on Future Meaningful Use Changes

By Jacqueline DiChiara

- The Department of Health and Human Services (HHS) has confirmed a 60-day period of public commentary regarding the Stage 3 Electronic Health Record (EHR) incentive program and the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2, MACRA). New requirements throughout the next two years have been outlined.

Meaningful Use MACRA

Now up for debate is how MACRA may influence upcoming Meaningful Use changes. Are CMS’ final rules actually anything but?

Says, CMS requests input regarding whether or not category scores for the meaningful use performance scores should reflect an all-or-nothing mentality.

What types of assessment measures, such as population health or outcome-based standards, should be included via the Merit-based Incentive Payment System (MIPS) is one of many similar questions concurrently up for debate.

Failure to comply with meaningful use mandates can lead to penalties only eradicated with a decision from Congress. Similarly, MIPS scores could drop with failure to participate in upcoming EHR Incentive Program initiatives. There is additional concern that MACA reforms overlap with present meaningful use efforts.

As reported, the Centers of Medicare & Medicaid Services delayed releasing the modification rule for 2015 through 2017, with the organization confirming “there was no real reason to delay its release until after the final 90-day period of 2015 had begun.” CMS says it will consider policy developments for the EHR Incentive Programs during rulemaking to implement MACRA.

“This final rule with comment period synchronizes reporting under the EHR Incentive Programs to end the separate stages of meaningful use, which we believe will prepare Medicare EPs for the transition to MIPS,” the final rule states.

The regulation aims to help flip the reimbursement switch from volume to value. According to CMS, MIPS helps meet HHS Secretary Sylvia M. Burwell’s goals to associate 85 percent of traditional Medicare payments to value by next year and 90 percent by 2018.

Regarding MIPS and payment adjustment amounts, CMS says the maximum payment adjustment amount begins at 4 percent in 2019, incrementally increasing to 9 percent in 2022 and beyond. From 2019 to 2024, another payment adjustment will be awarded to the top MIPS performers, says CMS.

As reported via an April interview with the National Center for Policy Analysis and the Independent Institute, MACRA fee adjustments are expected to generate financial consequences. CMS has already spent $29 billion of $30 billion on the program, which is allegedly a detriment to physicians. Payment may become simply dependent on EHR compliance.

Will upcoming regulations be able to effectively accommodate new changes along the healthcare horizon? MACRA will merely result in limited pay-for-performance initiatives which may drive physicians out of the industry due to insufficient payment rates, confirmed

The American Medical Association (AMA) commended CMS for permitting the hardship exception for physicians unable to attest because of 2015 program requirement uncertainty.

Other organizations, such as The College of Healthcare Information Management Executives (CHIME) and The Healthcare Information and Management Systems Society (HIMSS), shared similar sentiments.

Others naturally confirmed displeasure in the decision, citing such opinions as having missed a golden opportunity.


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