Confusion has swirled around the Quality Payment Program created under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Ever since the acronym MACRA became part of healthcare professionals’ shared vernacular, everyone has been trying to figure out how the new set of reimbursement guidelines from the federal government will impact bottom lines.
Last week, the Centers for Medicare & Medicaid Services (CMS) issued their final rule on the Quality Payment Program. Running well over 1,600 pages and steeped in regulatory legalese, the document is fairly dizzying in its own right. But it at least moves the healthcare industry closer to clarity as value-based care becomes an unavoidable reality. (And CMS was merciful enough to issue a 26-page summary.)
Naturally, reactions to the final rule have been mixed. It has already spurred at least one major legal action. Several hospital lobbying groups are suing over drastic cuts to the government’s 340B pharmaceutical pricing program, which allows safety net hospitals to purchase drugs at significantly reduced prices. Drug manufacturers claim the program is rife with abuse, but hospitals counter it is needed as they provide care to patients with limited or no health insurance.
As expected under the current administration, the final rule reduces the number of healthcare providers who must participate in the program. That extends a to a hardship provision, giving greater leeway to healthcare providers impacted by Hurricanes Harvey, Irma, and Maria.
The final rule also includes a new provision meant to make it easier for healthcare providers in small, rural areas to band together in implementation of the various value-based payment tools.
There’s a clear tilt toward supporting remote medicine in all its forms. There are financial incentives for physicians who gather and examine health data generated by various wearable devices. CMS has created several new telemedicine codes, clearing the way for healthcare providers to bill for treatment efforts conducted remotely.
In a statement, the American Hospital Association (AHA) ticked off the elements of the final rule it found troublesome, including “reducing Medicare rates for services hospitals provide in ‘new’ off-campus hospital clinics” and “short-sighted policies on the relocation of existing off-campus provider-based clinics.”
The AHA praised the expanded telehealth options, but urged the agency to take an even more proactive approach in that area.
CMS posted the final rule for public comment. Feedback is accepted through January 2, 2018.