MACRA Targets Meaningful in Meaningful Use

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By Barry P. Chaiken, MD, MPH 

The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) opened the way for the U.S. Department of Health and Human Services (DHHS) to streamline the quality improvement and healthcare information technology programs it built over the past several years.

Since the passage of the 2009 HITECH Act, the quality reporting and meaningful use criteria have grown in complexity and breadth, making their program guidelines difficult to follow. The proposed MACRA rule attempts to lessen the burden for physicians (a rule for provider organizations is under development) while working to better achieve goals of improved quality of care and effective use of information technology.

Currently, Medicare physicians submit data to a variety of uncoordinated quality reporting programs: accountable care organizations, the Comprehensive Primary Care Initiative, Medicare Shared Savings Program, the Physician Quality Reporting System, the Value Modifier Program, and the electronic health record (EHR) incentive program (i.e., meaningful use).

The proposed MACRA rule attempts to aggregate current reporting programs into a more manageable form by offering two distinct reporting options and reducing the number of metrics required overall. The new Quality Payment Program offers two paths: the Merit-Based Incentive Payment System (or MIPS) and the advanced Alternative Payment Models (or APMs).

The proposed rule targets only eligible clinicians who receive payment from CMS and includes a long list of providers in addition to physicians. The reporting period for quality measures begins in calendar year 2017, with the results impacting CMS payments in calendar year 2019.

DHHS expects most program clinicians to participate in the MIPS program. As outlined, the MIPS program adjusts reimbursement based on four areas:

  1. Quality—from a broader list, clinicians choose six key measures, with results accounting for 50% of the overall incentive score
  2. Cost—using claims, DHHS assigns a value equal to 10% of the overall incentive score
  3. Advancing Care Information—with emphasis on interoperability and information exchange, clinicians choose to report on their use of information technology, with this measure impacting 25% of the overall incentive score
  4. Clinical Practice Improvement Activities—from a list of 90 options, clinicians choose activities that match their practice, with results impacting 15% of the overall incentive score