HHS Leadership in Transition, but MACRA Forges Ahead
HHS secretary states support for value-based care
As the U.S. Senate considers the nomination of Alex Azar to be the new Health and Human Services Secretary, provider Medicare reimbursement changes are looming under the Medicare and CHIP Reauthorization Act (MACRA), while other mandatory Medicare payment reform initiatives have been scaled back or eliminated.
In November, the Centers for Medicare & Medicaid Services (CMS) released new rules for the second year of MACRA implementation. The first year effectively served as a trial run because most providers could avoid penalties by submitting some data to the program. However, the second year has more teeth. Despite protests from lobbyists, providers will begin to be scored based on the price of care; 10 percent of their Merit-based Incentive Payment System (MIPS) score is based on cost. Under MACRA, physicians who have enough Medicare patients are required to participate in MIPS if they are not engaged in a qualifying advanced alternative payment model (APM).
Providers’ reporting period will be a full year for quality and cost measures, while advancing care information and improvement activities must be reported for a minimum of 90 days.
There are questions about the future of MIPs because the Medicare Payment Advisory Commission recently voted to recommend that Congress eliminate MIPS and replace it with another incentive program that would use claims data to evaluate physician performance based on patient outcomes.
The advancement of MACRA signals the continuation of the transition to value-based care. On the other hand, the rollback of the Comprehensive Care for Joint Replacement (CJR) model for Medicare bundled payments, and the cancellation of the Episode Payment Models and the Cardiac Rehabilitation Incentive Payment Model for Medicare bundled payments, slowed the shift to value-based reimbursement. However, CMS recently announced a new reimbursement reform initiative called Bundled Payments for Care Improvement-Advanced. This new voluntary bundled payment model counts as an advanced APM under MACRA and is scheduled to take effect in October 2018 for 32 episodes of care, including three for outpatient care.
In comments made by Azar during Senate hearings, the nominee has indicated that value-based care still needs to be advanced, with technology taking a starring role. The nominee stated that his top priorities include incentives for providers to pursue improved Medicare outcomes. Azar’s takeover of HHS should put VBC in a better position to advance than under Tom Price, the previous HHS secretary, who mostly frowned upon reimbursement reform.
Some of Price’s goals appear to be staying, chief among them lessening the burden of electronic health record (EHR) requirements on providers. In Senate testimony, Azar agreed the burden on physicians could be eased, stating that reporting processes and EHR requirements for certain programs are causing issues. Instead, Azar suggested that greater interoperability among EHRs will lead to greater efficiency. Given these statements, it seems likely that Azar will push an EHR/technology advancement agenda aimed at increasing efficiency and interoperability.
Expect value-based care to slow down but continue at a controlled, steady pace in light of Azar’s Senate testimony, MACRA’s implementation, and adjustments to bundled payment programs. Some might say this slows progress, while others might argue that the VBC train was outpacing the technology tracks needed to succeed. Either way, the locomotive will move forward with a new conductor and technology as the fuel to move the whole train to its destination of higher quality care that is more efficient.