Physicians and healthcare organizations have flooded the CMS with concerns about MACRA, the proposed changes to the way Medicare pays providers. They say the rule puts patient data at risk and could actually push providers away from participating in payment models meant to lower costs while increasing quality of care.
The Medicare Access and CHIP Reauthorization Act aims to consolidate three existing payment models: the Physician Quality Reporting System, the Physician Value-based Payment Modifier and Medicare's incentive program for achieving meaningful use of electronic health records.
Agency officials said the new consolidated program will offer physicians greater simplicity and flexibility, providing two paths for physician payments when it goes into effect in 2019. Physicians can choose to participate in the Merit-based Incentive Payment System, or MIPS, or have a significant amount of their revenue generated under a qualifying alternative payment model, or APM.
The agency received nearly 4,000 comments by the June 27 deadline. The majority of comments were critical of the proposed rule.
Several providers said a requirement to submit quality information via a registry or EHR oversteps by asking providers not only for data on Medicare patients, but patients with other forms of coverage as well.
“Who gives CMS the right to private medical data from all patients' charts 'regardless of payer?' " Dr. Kristin Story Held, a Texas-based ophthalmologist says in a comment. “Contents of patient's medical records are confidential and constitute protected health information to which you have no right.”
“This is a disaster for psychologists since much of our work is predicated on assurances of patient-doctor confidentiality. Every day, we learn of additional breaches to databases and health-based platforms,” said Dr. Jeffrey Axelbank, a New Jersey-based psychologist.
Experts say providers are raising a valid point.
“Nothing in MACRA gives CMS statutory authority to require data from other payer enrollees be submitted,” said Bob Atlas, president of the EBG Advisors unit of healthcare law firm Epstein Becker and Green.
Others say the rule could discourage providers from participating in value-based purchasing initiatives. For instance, to quality for a 5% bonus, providers must participate in models that require significant financial risk.
“Although the clinicians participating in shared savings-only models are working hard to support CMS's goals to transform care delivery, under CMS's proposal they will not be recognized for those efforts,” Tom Nickels, the American Hospital Association's executive vice president of government relations and public policy, said in a statement
“We fear this could have a chilling effect on experimentation with new models of care among providers that are not yet prepared to jump into two-sided risk models.”
Providers across the country said the 963-page rule is simply too complex to understand, making it difficult to adhere to.
“The document is hard to understand, so working docs find it hard to comment, and are writing in" emotion-based responses, Dr. Jean Antonucci, a family doctor in Maine, said in a comment.
“The federal government just does not comprehend that the complexity of its rules results in lower levels of compliance,” said Annetta Cheek, chair of the government affairs committee for the Center for Plain Language, a not-for-profit based in Washington, D.C., that helps government, corporations and not-for-profits write more clearly.
The rule is expected to be finalized by Nov. 1.
