The Healthcare Information and Management Systems Society is concerned about the proposed rule on implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), particularly the timeline for rolling out the new Merit-Based Incentive Payment System (MIPS) for eligible clinicians, says Thomas Leary, vice president of government relations.

On April 27, the Centers for Medicare and Medicaid Services published its much-anticipated MACRA proposal, including details on MIPS. Specifically, CMS is attempting to usher in a new era in health IT with the introduction of a new Advancing Care Information (ACI) performance category score under MIPS, in which the Meaningful Use component is intended to move to a system that allows clinicians to select the measures that reflect how technology best suits their day-to-day practice.

In its MACRA rule, CMS proposes that the first MIPS performance period start on January 1, 2017. However, members of the HIMSS Government Relations Team believe that deadline is unrealistic.

Leary calls the proposed January 2017 start date “tight” for Medicare providers in terms of data collection for reporting. CMS proposes that the MIPS performance period would be the calendar year (January 1 through December 31) two years prior to the year in which the MIPS payment adjustment is applied, with the first payment year scheduled to begin in 2019.

MIPS would distribute payment adjustments to somewhere between 687,000 and 746,000 eligible clinicians in 2019. Payment adjustments would be based on MIPS eligible clinicians’ performance on specified measures and activities within four performance categories. CMS estimates that MIPS payment adjustments to eligible clinicians will be equally distributed between negative adjustments ($833 million) and positive adjustments ($833 million).

Also See: How MACRA will reshape providers’ HIT strategies

The proposed MACRA rule also establishes incentives for participation in certain alternative payment models (APM).

“MACRA, MIPS, and the APM categories are expected to all start January 1, 2017,” says Jeff Coughlin, senior director of federal and state affairs at HIMSS, noting this presents a “timing challenging” as CMS tries to finalize the rule by November 2016 at the latest. “Trying to implement something beginning January 1, 2017, I think is going to be challenging for a lot of different providers.”

In addition, Coughlin says the proposed rule is attempting to use “all available vehicles” to ensure providers demonstrate their adherence to interoperability and health information exchange, noting the “surveillance piece” included in the MACRA proposal. “All meaningful use providers must attest to the fact that they are facilitating information exchange,” he said. “It was a little bit of a surprise…the fact that they included it here just really emphasizes the importance that they’re placing on this.”

As part of demonstrating meaningful use under the Medicare and Medicaid EHR Incentive Programs, CMS would require eligible professionals and hospitals to attest that they have cooperated with the surveillance of certified EHR technology under ONC’s Health IT Certification Program. Further, the agency is proposing to require such an attestation from all eligible clinicians under the Advancing Care Information performance category of MIPS, including those who report on the ACI performance category as well as participation in an APM for the MIPS calculation.

When it comes to the list of APMs that CMS included in the proposed MACRA rule, Coughlin says he was surprised that the agency did not include Medicare Shared Savings Program (MSSP) Track 1 accountable care organizations with no downside risk, but did include Track 2 and 3 ACOs.

“Since there is no risk bearing as an ACO in the Track 1 model, I guess there had to be some sort of component of financial risk to be considered an advanced APM. I know CMS is trying to make efforts to push providers into Track 2 and 3 to bear some financial risk as part of that and maybe they’re using MACRA as a vehicle to try to do that.”

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