CMS chief medical officer Patrick Conway, MD, said "The proposed system would reward clinical practice improvements such as activities focused on care coordination, patient engagement, and patient safety, and also reduce reporting requirements... by reducing the number of measures required, and eliminating redundant quality reporting. From MedPage Today.
The Obama Administration proposed two rules Wednesday that officials say will ease physicians' documentation requirements and give them new opportunities to earn bonuses for providing high-quality care.
One rule implements what is called the Quality Payment Program, which gives doctors two options for getting reimbursed under Medicare: they can participate either in the Merit-Based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).
"There have been a myriad of programs [for physician payment] developed over the years," Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services (CMS), told reporters on a conference call. He gave alternative programs such as accountable care organizations and shared savings programs as examples. The Quality Payment Program "replaces all these programs with a single platform. Physicians will have the opportunity to get paid more for investments that support patients, and do so with minimal burden."
In addition, said CMS chief medical officer Patrick Conway, MD, "The proposed system would reward clinical practice improvements such as activities focused on care coordination, patient engagement and patient safety, and also reduce reporting requirements ... by reducing the number of measures required, and eliminating redundant quality reporting. If physicans do well in the program, they could earn more than a 4% bonus in incentive payments ... with additional bonuses for the highest performers."
Related: CMS: Meaningful Use for Physicians Would End in 2017
Physicians choosing the MIPS program would get paid based on their reporting on a single set of quality measures; the set combines measures from earlier programs such as the Physician Quality Reporting System and the Value-Based Payment modifier. However, to increase flexibility, "The program allows physicians ... to select quality measures from a range of options to reflect differences among specialties, and report technology utilization based on customizable measures that reflect how clinicians use technology in their day-to-day practice," Conway explained.
Those choosing the Advanced APM program would be paid based on their participation in newer payment models such as the Comprehensive Primary Care Plus model and the Next Generation Accountable Care Organization model.
Both programs are slated to go into effect in January 2017, beginning with a reporting period that will affect physician pay in 2019.
The second proposed rule makes changes to the highly unpopular Meaningful Use program, which requires physicians to document making "meaningful use" of electronic health records (EHRs). "We are proposing to replace Meaningful Use with a new effort that moves the emphasis away from the use of information technology to one that supports patient care that is supported by better and more connected technology," Slavitt said on a second conference call. "The program, Advancing Care Information (ACI), is designed to be more flexible and less burdensome," and would also take effect in January 2017, he said.
The ACI program "will allow physicians and other clinicians to select measures to reflect how [information] technology best suits their day-to-day practice; the proposal eliminates a number of measurements and entirely focuses on patient care and connectivity goals," Slavitt said. "The proposal allows 'acknowledgement reporting' to comprise 50% of the program, and it removes the all-or-nothing grading system. It also aligns with other quality and reporting programs, so it's simpler."
The proposed rule, which will be available for 60 days for public comments, applies only to physician offices, not to hospitals, and only to Medicare payments, not to Medicaid, he noted. "Even after it's implemented, as the programs meet the real world and physicians and patients begin having actual experience with it, we will need to continue" to listen to clinician concerns.
The expectations included in the ACI program "support our work around the changing culture of data-sharing," said Karen DeSalvo, MD, MPH, national coordinator for Health Information Technology (IT). "It advances... expectations around transparency reporting for vendors and putting information out into the public domain so clinicians are better able to compare products and understand what they're actually purchasing. There is also an expectation upon providers themselves ... attestations they will not block data and that it's moving on behalf of consumers."
Asked if there were any provisions in the rule that would penalize vendors who tried to block data, DeSalvo replied that although the rule applies to providers rather than vendors, her agency is working to prevent data blocking "through every lever we can find, through voluntary certification and otherwise, working in concert with providers and health IT developers."
"The 'good news' story is that everybody has a shared goal that we begin to compete within standards, not between standards, and toward meeting expectations of everyone in the country that their health information will be available when and where it matters to them," she told MedPage Today. "Through creating the right business case, we're creating an environment where people will continue to work together ... we want to help make sure it makes business sense for everybody."
The rules got positive reviews from several physician groups. "Our initial review suggests that CMS has been listening to physicians' concerns," Steven Stack, MD, president of the American Medical Association, said in a statement. "In particular, it appears that CMS has made significant improvements by recasting the EHR Meaningful Use program and by reducing quality reporting burdens."
He also announced that the AMA was releasing "new online information and resources to help physicians navigate the changing landscape."
The American Academy of Family Physicians (AAFP) also applauded the proposed rules. "Today's proposed regulations move toward meeting Congressional intent, which is to place greater priority on primary care that is comprehensive, continuous, coordinated, connected and a patient's first contact with the healthcare system," AAFP president Wanda Filer, MD, MBA, said in a statement.
"The law's emphasis on these priorities ... is a direct expression of the Congressional desire to see our healthcare delivery system more aggressively promote, reward and emphasize primary care."