A 'simpler' version of meaningful use: 8 things to know about HHS' proposed MACRA rule

Three months after CMS Acting Administrator Andy Slavitt hinted at the end of the meaningful use program, HHS released proposed rules Wednesday outlining how incentives will continue under what officials describe as a more simple framework.

Folded into the proposed provisions of the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, is the new iteration of the meaningful use program.

Here are eight things to know about the changes.

1. The MACRA legislation only applies to eligible Medicare clinicians, so hospitals and eligible professionals participating in Medicaid meaningful use programs will not be affected by the legislation. In a media call, Kate Goodrich, MD, director for clinical standards and quality at CMS, said the agency is working with states and Medicaid providers to understand where they would like to see changes if possible.

2. Under the proposed rule, providers participating in Merit-based Incentive Payment System will receive a score based on four performance categories, one of which — Advancing Care Information — relates to how clinicians use technology in their everyday practice. This performance measure will make up 25 percent of a clinician's MIPS score.

3. There are two components to the Advancing Care Information category of MIPS. The first is the base score, where clinicians can earn half of the total allocated points just by reporting on measures. They can earn the second half of the points depending on their performance of those measures. Participating clinicians will be allowed to select which measures to submit that best reflect how technology suits their practice. Certain measures, such as computerized physician order entry and clinical decision support tools, have been eliminated.

"This is where the flexibility for clinicians to report on measures that are most meaningful to their practice comes in," Dr. Goodrich said.

Additionally, providers can earn a bonus point in the Advancing Care Information category if they report on more than one public health registry.

4. The rule builds upon the 2015 Edition EHR Certification Criteria. "Health IT developers should continue to build for the 2015 edition because this rule…will apply to the 2015 edition," Karen DeSalvo, MD, national coordinator and acting assistant secretary for health, said on the media call.

That said, providers using IT under the 2014 edition in 2017 will still be able to meet meaningful use requirements, because the requirement to use IT under the 2015 edition does not take effect until 2018.

5. Under the proposed rule, there are no longer penalties for providers who do not participate. CMS appears to have replaced the stick with a carrot. Since participating providers submit measures that produce a score, providers who do not comply with the IT component of the overall MIPS score will essentially receive a zero for the category but will still be scored in the other categories.

6. Under the proposed rule, the MIPS performance period starts in 2017, and will affect payments in 2019.

7. "Over the last seven years, meaningful use has played an important role in helping us develop the IT infrastructure that we have and can now build from," CMS Acting Administrator Andy Slavitt said on the media call, also mentioning the advancements the healthcare industry has made in transitioning its focus to quality and outcomes, saying more than 30 percent of Medicare payments are through fee-for-service programs. "All of this taken together has given us the opportunity to step back and conduct a full review of the meaningful use program so we can move to the next level of how technology can support us in a world with a more mobile patient and a need for more connected and coordinated care."

8. The proposed rule is open for public comment for the next 60 days.


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