To effectively transition from fee-for-service to value-based payment model, there is a need to reassess and redefine current regulations such as MACRA. The regulatory burden i.e., duplicate or outdated regulatory requirements are not only increasing the cost of care but also shifting the focus from the top priority, i.e., patients. To reinvent the existing regulatory system, CMS has initiated a three- pronged approach.
1. Meaningful Measures
- Re-examine the process of conducting quality measurement across various programs
- Focus on high priority areas by gauging core issues that are imperative to deliver high quality care
- Revise and redefine the current set of quality measures across all programs to ensure new measure sets are outcome-based and meaningful to physicians & patients
- Streamline the measures that hospitals and physician practices must report on.
- Focus on core issues that are vital to providing high-quality care and improving patient outcomes.
- Review the Hospital Star rating program
- Report on fewer measures to reduce the burden on physicians and hospitals and give them more time with patients
- Shift the focus to outcome-based measures over process-based measures (No micromanagement of processes)
- Focus on public health measures (e.g., measures around prevention and treatment of opioid addiction)
2. Patients over Paperwork
- Gather information about the CMS regulations which are burdensome and involve paperwork. (CMS workers would be collecting this information from physicians nationwide)
- Reduce paperwork that consumes critical provider time, money and resources, enabling them to spend more time with patients.
- Revisit all the regulations. Improve or eliminate burdensome regulations which no longer achieve the goal of ‘Patient First’.
- Streamline the areas of regulation and lower regulatory compliance needs (629 mandatory regulatory requirements as of now) thereby reducing the cost of administrative activities.
3. New Direction for Center for Medicare and Medicaid Innovation (CMMI)
- Promote greater flexibility and patient engagement
- Review all current Innovation Center models to determine their effectiveness
- Seek new ideas and feedback on future direction for the Innovation Center through an RFI to all stakeholders
- Focus on the following areas:
o Increased participation in Advanced Alternative Payment Models (APMs)
o Consumer-Directed Care & Market-Based Innovation Models
o Physician Specialty Models
o Prescription Drug Models
o Medicare Advantage (MA) Innovation Models
o State-Based and Local Innovation, including Medicaid-focused Models
o Mental and Behavioral Health Models
o Program Integrity
These new initiatives would have a major impact on quality reporting programs. As outcome-based quality measures have a definitive result, CMS is likely to put more emphasis on these measures. Registries / QCDRs and other entities collecting and submitting quality data would have to rethink their strategy on the selection of quality measures, in case the process-based measures may not be supported going forward. Simpler and more efficient quality reporting would require providers to spend lesser time on compliance. Providers have the opportunity to participate in other payment models such as the upcoming Voluntary Payment Bundles that qualify as Advanced APMs under MACRA.