HHS' Office of Inspector General says the CMS has made significant progress on implementing Medicare's new payment framework for physicians. But the watchdog agency also named technology systems and technical assistance to providers as a critical challenge still ahead.
In the 40-page report, the OIG said the “CMS has built a promising foundation” for managing clinicians' transition to MACRA. The report highlighted efforts made by the CMS to help physicians adapt to the final rule, such as launching the Quality Payment Program website and broadening opportunities for physicians to participate in alternative payment models.
“Early on, CMS staff decided that clinicians' acceptance of the Quality Payment Program, and readiness to participant in it, would be the most critical factor to ensuring the program's success,” the OIG said in the report.
But the report also cautions that the CMS must continue to provide assistance to clinicians so they can comply with the Medicare Access and CHIP Reauthorization Act, which was issued in October.
The OIG said the CMS' technical assistance and training efforts for physicians “must quickly be ramped up to full-scale.” The OIG specifically highlights the importance of ensuring small and rural practices have all the tools they need to comply with MACRA.
The CMS should monitor and oversee the performance and effectiveness of contractors that provide technical assistance to ensure clinicians can select the option that best suits their practice, the OIG said. Under MACRA, most physicians must choose one of two reimbursement tracks: the Merit-based Incentive Payment System or an advanced alternative payment model.
The OIG also said it's “crucial” the CMS build and test IT systems to conduct key provisions of MACRA including data submission, calculation of MIPS final scores and payment adjustments.
In response to the report, the CMS said a variety of technical assistance efforts are underway and the agency is working on optimizing IT systems.
The CMS staff also noted that they drew on failures from the rollout of HealthCare.gov to launch MACRA. One CMS official said, “HealthCare.gov was a really low moment for the agency, but it was a learning moment, which allowed us to learn the lessons of how to build new muscles (from the turnaround of) HealthCare.gov and apply them to the MACRA program.”
In order to evaluate the MACRA rollout, the OIG interviewed CMS staff, reviewed CMS internal documents and publicly available information.