Health IT

Lots of groups still have issues with MACRA, health IT certification rules

Responses were mixed, which probably isn't that big of a deal, given that Acting CMS Administrator Andy Slavitt said Friday that MACRA was a "living, breathing rule" intended to change over time.

Politician talking into reporters' microphones

Friday, the Department of Health and Human Services gave the health IT universe a double whammy of regulations. First, the Office of the National Coordinator for Health Information Technology updated its standards for certification of electronic health records. Then, the Centers for Medicare and Medicaid Services dropped a 2,400 page rule to implement the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

The CMS release actually came a day after the Medicare agency formalized a plan to ease the reporting burden on physicians in the new MACRA-authorized Quality Payment Program that replaces the Sustainable Growth Rate in 2017.

It was a lot to digest, but that didn’t stop multiple groups from reacting almost immediately. Responses were mixed, which probably isn’t that big of a deal, given that Acting CMS Administrator Andy Slavitt said Friday that MACRA was a “living, breathing rule” intended to change over time. In fact, CMS is breaking with tradition by taking public comments on a final rule for 60 days.

Here’s a sampling of what various organizations had to say about MACRA, the certification rule and the Quality Payment Program, including the new Merit-based Incentive Payment System (MIPS).

Given its usual anti-regulation stance, the American Medical Association was noticeably upbeat about getting rid of the Sustainable Growth Rate and happy that CMS listened to its concerns about the earlier proposed MACRA rule.

“Our initial review indicates that CMS has been responsive to many of the concerns raised by the AMA, and in the days ahead, the AMA will conduct a comprehensive review of the final rule to ensure that it promotes flexibility and innovation in the delivery of care to help meet the unique needs of all patients,” said AMA President Dr. Andrew W. Gurman,

“With the flawed Sustainable Growth Rate (SGR) formula – and its annual threat of steep payment cuts – permanently eliminated, the new law gives many physicians the opportunity to be rewarded for the improvements they make to their practices and for delivering high-quality, high-value care to Medicare patients,” Gurman added.

The Medical Group Management Association was less effusive.

“MGMA is pleased with the significant burden reduction for physician practices in the first year of the MIPS program and new alternative payment model options outlined in the final rule,” President and CEO Dr. Halee Fischer-Wright said.

“It’s disappointing that flexibility provided for quality reporting in 2017 largely disappears in 2018 and beyond. The Centers for Medicare and Medicaid Services missed an opportunity to close the two-year gap between the measurement and payment periods, which would facilitate improved patient care by providing actionable feedback to physicians and more timely incentives. The sheer magnitude of a 2400-page regulation and its impact on physician practices can’t be ignored,” Fischer-Wright continued.

The College of Healthcare Information Management Executives (CHIME) also had a lukewarm initial impression of the rules. This statement comes from CHIME Vice President for Federal Affairs Mari Savickis:

While we are still reviewing the 2,400-page rule, the Centers for Medicare and Medicaid Services [Friday] seemed to take important steps in giving physicians much-needed flexibility for adopting health information technology as they transition to a new payment model. For instance, the final rule reduces the reporting burden on clinicians by giving them the option of a 90-day reporting period, or a full year. It also reduces the number of measures upon which clinicians must report.

Unfortunately, CMS appears to have retained stringent language requiring hospitals and clinicians to attest that they are not engaging in information blocking. The agency does, however, clarify that 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.”

Meanwhile, the Office of the National Coordinator for Health IT [Friday] finalized a rule covering certification and oversight of certified health information technology. CHIME appreciates that steps that the agency is taking to increase transparency of health IT performance. Hospitals and clinicians must have confidence that the products they purchase work as intended and do not pose a significant risk to patient safety or public health.

Health IT Now, a wide coalition of payers, providers, technology vendors, employer groups and patient advocacy organizations, was particularly miffed with the ONC certification plan.

“ONC is clearly overstepping its statutory authority by moving forward with direct review of uncertified functionalities and products, in addition to certified products. By focusing on safety issues, ONC is encroaching on the regulatory functions of other federal agencies like the FDA,” Executive Director Robert Horne said in a blog post. (Emphasis in original.)

“The FDA, Congress, and other stakeholders have been working for many years to strike an appropriate balance between supporting innovation and regulatory clarity for health IT products. Much progress has been made, with more work needing to be done. This ONC action has the potential to negatively impact those efforts, create confusion in the marketplace, slow innovation, and adversely affect patient safety by impeding access to health IT products,” Horne continued.

Health IT Now urges the White House to reconsider this approach. We also urge Congress to use its authorities to prevent this rule from being implemented, including the withholding of appropriations,” he wrote, all in boldface.

 

 

Shares0
Shares0