MACRA: A look at the final rule on physician quality payments and EHR transition

Rebecca Vesely

About Rebecca Vesely

Rebecca Vesely is AHCJ's topic leader on health information technology and a freelance writer. She has written about health IT since the late 1990s for a variety of publications.

The federal government released its final rule for 2018 on a law that governs physicians’ adoption of electronic health records and rewards them for meeting quality measures when treating Medicare patients.

However, the final rule includes some changes that mean that fewer physicians will be required to participate. One prominent physician group said that the rule will slow the transition to value-based care.

The law, the Medicare Access and CHIP Reauthorization Act of 2015, known as MACRA, created the Quality Payment Program (QPP). This QPP reimburses physicians who treat Medicare beneficiaries based on meeting quality benchmarks and their continued transition to electronic health records. The program started in January 2017.

The final 1,653-page rule for 2018 was released on Nov. 2 by the Centers for Medicare and Medicaid Services (CMS). The public comment period is open until Jan. 1, 2018.

Under the QPP, providers can choose two tracks: one is the Merit-Based Incentive Program (MIPS), and the other is the Advanced Alternative Payment Model (APM). Most physicians fall under MIPS.

Here are a few highlights of the final rule:

  • Physician practices with less than $90,000 in Medicare revenue or fewer than 200 unique Medicare patients are exempt from the program.
  • Physician practices impacted by recent hurricanes in southern states can receive a hardship exemption.
  • Only about 40 percent of the 1.5 million physicians who treat Medicare patients will be participating in the MIPS program.
  • New billing codes will allow physicians to get reimbursed for some types of virtual visits.
  • Small, solo and rural physicians can band together and form “virtual groups“ to participate in MIPS, with a deadline of Dec. 1 for the 2018 performance year.
  • Physicians can use either 2014 or 2015 certified EHR technology in 2018 – but Medicare gives a 10 percent bonus to those using the newer 2015 version.
  • Some physician groups were critical of the final rule. The American Medical Group Association (AMGA) said in a statement that the rule “will slow the transition“ to value-based care. The AMGA said that the final rule on MIPS “amounts to little more than a regulatory compliance exercise“ rather than a true transition to paying for value.
  • CMS Administrator Seema Verma said in a press release the changes are designed to reduce the regulatory burden on physicians.

MACRA is a tough topic to cover for a general audience because of its complexity and because it might not seem relevant.

The real question to keep in mind is whether a law that could help hold physicians more accountable for the care of elderly and medically fragile patients will ultimately succeed in that aim.

Further reporting:

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