October 21, 2016

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This week's BOG Update is brought to you by Paul Casale, MD, MPH, FACC – Member of the Board of Trustees and Chair of the Population Health Management Task Force.

What the Final MACRA Regulations Mean for Cardiology in 2017

On Oct. 14, the Centers for Medicare and Medicaid Services (CMS) released the 2398-page final rule for the Medicare Quality Payment Program (QPP) created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The final rule includes the policies for the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (Advanced APM) participation that will be used to determine Medicare clinician payment starting in the 2019 payment year, based on 2017 performance.

Much of the content in the final rule document summarizes the thousands of comments received from the public, including from the ACC. It is clear that CMS listened to the clinician community and made changes based on this feedback. Some positive changes that we have seen so far include:

  • The "Pick Your Pace" program will allow clinicians and groups to avoid a penalty under the MIPS program by simply reporting at least one measure. Clinicians and groups that strive to report data across all MIPS categories for at least 90 days, or ideally, the full 2017 calendar year, will be eligible for bonuses. Cardiologists have historically had high participation rates under the current Medicare quality reporting programs, so we anticipate many members will be able to transition into the MIPS program using one of the new pathways.
  • The Advancing Care Information (formerly EHR Incentive) category of MIPS requirements have been reduced from 11 required measures to 5 measures for full credit.
  • CMS has lowered the scoring weight for the Resource Use (cost) MIPS category to 0 percent for the first year of the program, recognizing that many procedures and conditions have not yet been tested for use at the clinician level. As a result, the 2017 performance year MIPS weight for Quality will be increased to 60 percent.
  • The Advanced APM pathway is being expanded to include more clinicians by recognizing more APMs as Advanced, including simplifying the definition of the financial risk that an APM must assume in order to qualify.

As you know, the "devil is in the details," so we continue to review the final rule and will continue to work with CMS, Congress and other stakeholder groups as the program is implemented. We know that policies will need continued refinement to ensure that these programs are successful.

Your ACC is prepared to support members throughout this transition to the MACRA Quality Payment Programs. Through November, the College will continue its efforts to educate members about the four core components of the QPP: quality, meaningful use of certified electronic health records (EHRs), clinical practice improvement activities (CPIA) and resource use. Issue briefs on quality and EHR use are available now. Briefs on CPIA and resource use will be available in the coming weeks. Communications Toolkits for each topic are being distributed to Chapter Executives so they can easily plug information into chapter communications channels.

Late this year and throughout 2017, the ACC will roll out cardiology-specific materials tailored to various member groups to ensure successful navigation of the new program. The 2017 Cardiovascular Summit will feature numerous sessions on MACRA implementation and the College will leverage ACC.17 and other meetings throughout the year to inform and educate members on this crucial topic.

In case you missed it, C. Michael Valentine, MD, FACC, Vice President of the ACC, and Pascha Schafer, MD, FACC, an ACC Emerging Advocate, provided a comprehensive overview of MACRA during a Facebook Live interview from Legislative Conference. Check it out here. Visit the MACRA Hub on ACC.org for the latest MACRA information and resources.