Policy & Regulation News

Final MACRA Implementation Rule to Drive Patient Engagement

In finalizing MACRA and the Quality Payment Program, HHS has enacted provisions to improve patient engagement and quality care.

By Sara Heath

- HHS has issued the final rule for the Quality Payment Program as part of MACRA implementation, and it has considerable implications for patient-centered care and patient engagement,  the federal agency announced Friday.


MACRA aims to improve patient engagement and patient-centered care through the law’s Quality Payment Program, which replaces the sustainable growth rate and equips providers with better flexibility to deliver quality care.

“With these objectives we recognize that the Quality Payment Program provides new opportunities to improve care delivery by supporting and rewarding clinicians as they find new ways to engage patients, families and caregivers and to improve care coordination and population health management,” CMS said in an executive summary of the nearly 2,400-page rule.

The Quality Payment Program, slated to begin on January 1, 2017, is a two-pronged program including Advanced Alternative Payment Models (Advanced APMs) and the Merit-based Incentive Payment System (MIPS).

Advanced APMs – which can include advanced accountable care organizations, patient-centered medical homes, and certain bundled payment options – may support patient-centered care by requiring providers to meet overall wellness benchmarks.

In order to be recognized as an Advanced APM, APMs must reimburse eligible clinicians based on patient-centered clinical quality measures and require that eligible clinicians share in monetary losses due to lack of quality, patient-centered care.

Additionally, eligible clinicians must utilize certified EHR technology in order to provider better care coordination and patient-centered care.

MIPS fosters patient-centered care and engagement through robust data sharing requirements. Advancing Care Information, one of four performance categories in MIPS, requires eligible clinicians to use CEHRT to provide patient access to health data, provide patients summaries of care, and provide view, download, and transmit capabilities.

Additionally, eligible clinicians must meet secure direct messaging requirements, furthering patient engagement.

According to CMS, patient-centered care is the foundation of the Quality Payment Program.

“Indeed, the bedrock of the Quality Payment Program is high-quality, patient-centered care followed by useful feedback, in a continuous cycle of improvement,” CMS explained.

HHS Secretary Sylvia M. Burwell mirrored those sentiments in the press release announcing the final rule.

“Today, we’re proud to put into action Congress’s bipartisan vision of a Medicare program that rewards clinicians for delivering quality care to their patients,” Burwell said.

“Designed with input from thousands of clinicians and patients across the country, the new Quality Payment Program will strengthen our health care system for patients, clinicians and the American taxpayer.”

The MACRA and Quality Payment Program implementation, is a part of the broader industry transition from volume to value, CMS explained.

Starting in January 2015, HHS and CMS has been on a mission to improve healthcare to serve patient needs by linking Medicare payments to quality care. MACRA is intended to continue that mission.

“This is part of an overarching Administration strategy to transform how health care is delivered in America, changing payment structures to improve quality and patient health outcomes,” CMS explained in the rule’s summary.

“The policies finalized in this rule are intended to continue to move Medicare away from a primarily volume-based FFS payment system for physicians and other professionals.”

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