Life Science Compliance Update

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October 14, 2016

MACRA Final Rule to Be Released Today - Promises to Bring a New Level of Transparency

According to Politico, this morning Friday October 14, 2016 the MACRA final rule is being released by HHS.

While the final details still emerge, there is are may transparency measures which will surely be in the final rule.

As we have reported, MACRA increases the financial incentives for organizations to participate in value-based care models and take on more risk. MACRA is likely to accelerate a shift that has been occurring and will get providers to take an even closer look at opportunities to improve on cost and quality. However, cost and quality data will be public like never before, raising a number of transparency questions.

Issues of Transparency

The Advisory Board's Austin Weaver points out one of the lesser studied impacts of MACRA: transparency. In an article on the Advisor Board's website, Weaver notes: "the law will bring about a drastically different era of transparency, in which all performance on quality, resource use, and the other scoring categories will be made public for all providers. Most of that information has never been made public before. That transparency, in which the public will know whether you are considered—rightly or wrongly—to be a low-quality, high-cost provider, is likely going to affect the behavior of health care organizations."

He further suggests the data could be used as a point of conservation as organizations decide whether to form partnerships. "It'll force more scrutiny about whether they make good partners, and it could affect the conversations providers have with payers about their value proposition."

This is echoed by the Network for Regional Healthcare Improvement. Because MACRA requires compliance for reimbursement from Medicare and results will be made available for public review, "there's reason to expect that MACRA will drive change for all patients and encourage broad-based transparency and accountability." Specifically, beginning July 1, 2017, CMS is proposing to provide performance feedback to physicians on MIPS quality and resource use. CMS will also continue publishing data through Physician Compare.

MACRA also expands permissible uses of CMS data to allow qualified entities (QEs) to provide or sell analyses of data to authorized users for non-public use. Authorized users include providers/suppliers, issuers, employers, medical societies/hospital associations, and any other entity approved by the Secretary of HHS. QEs may also provide/sell combined data or provide Medicare claims data at no cost to providers/suppliers and medical societies/hospital associations for nonpublic use.

More information needed from CMS

To help groups prepare for this new level of data transparency, organizations like the American Medical Association (AMA) have called upon CMS to make changes. The AMA wrote to CMS that it is inappropriate to begin using episodes for MIPS in ways that could potentially penalize physicians before CMS has provided additional information needed to evaluate their suitability. Although CMS has released lists of the diagnosis and procedure codes used to define these episode measures, to achieve true transparency and facilitate insightful input, additional information must be made available. Rather than just a generic discussion of the risk adjustment methodology, for example, CMS must release the actual variables, coefficients, and equations used for the risk adjustment process, as well as the predictive accuracy of the methodology.

Inevitable increase in data

The healthcare delivery world is rapidly becoming more transparent. Efforts by consumers, the government, and private institutions to make price and quality data available are growing and they will transform how healthcare executives think and operate. The challenges posed by the growing demand for transparency will require advance planning, new investments, and new ways of conducting the business of caring for patients. Consumers can already access data points and overall ratings through government sources like Hospital Compare and Physician Compare, third parties like HealthGrades, Leapfrog, and Consumer Reports, insurance companies' cost estimators, and a growing number of other websites and apps. MACRA's data appears to be yet another part of this broader component of transparency-related programs.

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