MACRA rule won’t achieve payment reform ‘overnight’

The 2,400-page final MACRA rule that the Centers for Medicare and Medicaid Services released on Friday will take many years to fully implement as the healthcare industry transitions from fee-for-service to a Medicare payment system that rewards providers for quality patient care.

That’s the contention of Andrew Gettinger, MD, chief medical information officer and executive director of the Office of Clinical Quality and Safety in the Office of the National Coordinator for Health Information Technology.

“It is a pivotal time in the healthcare ecosystem. We have a system that historically has rewarded fee-for-service care and encouraged behaviors that aren’t the ones that we want to encourage,” Gettinger told attendees at the AHIMA 2016 conference on Monday in Baltimore.

“We want to have outcomes that are successful. We want to have quality. And, we want to take those two things and that’s what we want to reward,” he added, referring to the new Quality Payment Program which leverages the use of certified EHRs and health IT to improve the flow of health information among clinicians as well as achieve better quality of care.

However, Gettinger contends that CMS will not be able to solve what ails the industry with “one rule, overnight.” While the provisions of the final MACRA rule—with comment period—take effect on Jan. 1, 2017, realistically he believes reforming how the healthcare system pays for care is a decade-long transformation.

“If you go back in the history of HIT, you will find everybody projects 10 years,” according to Gettinger. “Outcomes-based payment and quality-based payment will take us a substantial amount of time.”

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Moving away from a fee-for-service healthcare system to one that uses alternative payment models that reward quality of care over quantity of services will “not be perfectly right from the outset,” he said, but the federal government is committed to the success of the Quality Payment Program.

“We envision that it will take a few years to reach a steady state in the program, and we therefore anticipate a ramp-up process and gradual transition with less financial risk for clinicians in at least the first 2 years,” states a CMS executive summary of the new Quality Payment Program.

“In the transition year in 2017, we will test this performance category alignment, for example by allowing certain improvement activities that are completed using Certified EHR Technology to achieve a bonus score in the advancing care information performance category with the intent of analyzing adoption, and in future years, potentially adding activities that reinforce integration of the program.”

Also See: Health IT grows in importance in final MACRA rule

When it comes to using certified health IT, Gettinger noted that last fall ONC released its 2015 Edition Health IT Certification Criteria which will provide the HIT foundation for the new Quality Payment Program, including interoperability-focused standards for certified EHR systems.

“That 2015 Edition, even though it came out a year ago, are the requirements that are baked into MACRA,” he said, adding that developers should be fine given that the regulations don’t go into effect until 2018, a full three years from the release of 2015 Edition Health IT Certification Criteria. “So, when you hear: ‘Oh my God, we’re not sure what we have to do in order to be MACRA-compliant’—we told you a year ago.”

On Friday, the same day that the final MACRA was released by CMS, ONC issued its own rule codifying modifications and new requirements under the Health IT Certification Program in an effort to protect public health and safety as well strengthen the accountability and transparency of certified HIT.

The Enhanced Oversight and Accountability Rule provides a regulatory framework for ONC to directly review certified HIT products and take the necessary actions in circumstances involving potential risks to public health and safety.

“It didn’t change any of our other regulations,” Gettinger concluded. But, he emphasized that “if things aren’t going all so well, we’re going to take the responsibility to actively engage and find out what’s going—we’re still working out exactly how that exactly is going to work.”

But, Health IT Now, a coalition of patient, provider and payer groups, charged that ONC “was not created by Congress to be a regulator like the Food and Drug Administration” and that the agency is “clearly overstepping its statutory authority by moving forward with direct review of uncertified functionalities and products, in addition to certified products.”

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