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CMS releases draft MACRA regulations



The Centers for Medicare and Medicaid Services (CMS) on Wednesday released a 962-page proposed rule that lays out the agency's plan for implementing last year's groundbreaking Medicare reform law, the Medicare Access and CHIP Reauthorization Act (MACRA).

Ahead of CMS’ release of the rule, physician leaders testified before the U.S. House of Energy and Commerce Committee’s Subcommittee on Health during a special MACRA hearing last week. The physicians expressed cautious optimism and said the law represents a critical opportunity to enhance flexibility and innovation in health care that can lead to improved care and better outcomes for patients, but the law also needs to allow physicians to focus on practicing medicine by aligning and simplifying quality reporting programs.

“MACRA makes significant improvements over the current system, including the repeal of the flawed sustainable growth rate formula and giving the Centers for Medicare and Medicaid Services an opportunity to reset and improve performance measurement as well as other requirements,” said Barbara McAneny, M.D., immediate past chair of the American Medical Association (AMA) Board of Trustees, who testified at the hearing. “By increasing the availability of alternative payment models, CMS will spur innovative delivery models focused on enhanced care coordination that can lead to better outcomes for patients.”

The proposed regulations
While there has not yet been time to digest and dissect the entire 962-page regulation, initial reviews indicate that CMS has listened to the input provided by the California Medical Association (CMA), AMA and others in organized medicine over the past year. Since MACRA was passed last spring, organized medicine has been providing extensive physician feedback on MACRA implementation.

Among other issues, the proposed rule addresses questions about elements of MACRA's Merit-Based Incentive Payment System (MIPS), including:

Quality: Clinicians would choose six measures to report, rather than the current requirement of nine, from among a range of options that accommodate differences among specialties and practice settings.

Advancing care information: Clinicians would be able to choose customizable measures that reflect how they use technology in their day-to-day practice. Unlike the existing meaningful use program, this category would not require all-or-nothing electronic health record measurement or redundant quality reporting.

Clinical practice improvement activities: Physicians would be rewarded for clinical practice improvements, such as activities focused on care coordination, patient engagement and patient safety. Clinicians would select activities that match their practices’ goals from a list of more than 90 options.

CMA and AMA will continue to work closely with CMS as the agency revises the regulations over the coming months.



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