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Geneia’s health plan client reports statistically-significant increases in 16 key HEDIS® measures
October 19, 2016
Heather Lavoie, Chief Strategy Officer, Geneia
It arrived last Friday, two weeks ahead of schedule and 1,400 pages heftier than the proposed rule it replaced. In just over six months, the MACRA (Medicare Access and CHIP Reauthorization Act of 2015) team held a listening tour, which was attended by more than 100,000 people. They combed through more than 4,000 written public comments. Comments and sentiment synthesized into the final rule that is widely accepted as simpler to understand and easier to begin and navigate.
Acting Centers for Medicaid and Medicare Services (CMS) Administrator Andy Slavitt said, “[MACRA] is a first step of a multi-year journey in which we are particularly focused on allowing clinicians to transition at their own pace.” Understanding that true transformation takes time, CMS established 2017 as a transition year, granting clinicians time to properly prepare while maintaining a focus on their patients and medical practices. For clinicians already engaged with value-based care, MACRA provides attractive rewards and higher rate increases.
While some clinicians are currently engaged in value-based care and largely prepared for MACRA, substantially more are not. The final rule acknowledged this and created four distinct reimbursement paths. For 2017 only, clinicians reporting via MIPS have three clear options:
Advanced APM track: a 5 percent bonus payment will be earned by clinicians receiving 25 percent of their Medicare payments and seeing 20 percent of their Medicare patients through an advanced APM.
Last spring, the proposed rule garnered much attention for its potential harm to small, independent practices. In addition to the flexible reporting requirements, the final rule makes several
key accommodations to ease the transition and help alleviate concerns:
CMS estimates that 25 percent, more than 125,000 clinicians, will participate in advanced APMs by 2018. This expected increase is the outcome of several changes:
As participation in the advanced APM track increases, bonuses become harder for each clinician to achieve.
In the proposed rule, the beginning bonus threshold of 25 percent of payments and 20 percent of patients funneling through an advanced APM did not change until 2021, where they increased to 50 and 35 percent respectively. These thresholds remained level until 2023 where they increased to 75 and 50 percent, respectively.
In comparison, the final rule threshold increases are two years faster across the board:
Reporting on technology use has become burdensome and redundant. The MACRA final rule hopes to ease this burden and contains one-third the requirements of Meaningful Use and less than half the requirements of the proposed rule.
The technology requirements in the final rule focus on patient engagement and safety, clinical effectiveness, data security, and the sharing of data (interoperability). The final rule has removed requirements surrounding clinical decision support and computerized physician reporting capabilities. The five “Advancing Care Information” requirements are:
Bonus points are available for clinicians through optional measures such as reporting to clinical data registries or utilizing EHR technology.
Healthcare veterans know that change takes time and input from many points of view. Just as the proposed rule improved through the sharing of opinions, the MACRA final rule has a companion 60-day open comment period.
We will continue to digest MACRA and share our opinions. Below are additional resources:
Scalable, cost-effective personalized care now possible for the Medicare Advantage population
Tech-enabled healthcare transformation improves patient engagement, diagnosis accuracy and care quality