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In the final months of the Obama administration, CMS released rules of significant import to healthcare providers, including a final rule explaining how the <a href="https://www.healthlawupdate.com/2016/11/making-sense-of-macra/">Quality Payment Program</a> mandated by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will work and a final rule (<a href="https://www.healthlawupdate.com/2017/01/cms-finalizes-mandatory-cardiac-and-joint-bundles-but-their-future-is-uncertain/">Final EPM Rule</a>) that implements two new cardiac bundled payment models and makes changes to the Comprehensive Care for Joint Replacement (CJR) program that began in April 2016. While the long-term future of MACRA and the bundled payment models is uncertain under the Trump administration, especially now that critic Tom Price has been confirmed as the secretary of the U.S. Department of Health and Human Services, CMS provided clarity in a <a class="js-autopdflink" href="https://www.gpo.gov/fdsys/pkg/FR-2017-02-17/pdf/2017-03347.pdf" target="_blank" rel="noopener">February 17</a> final rule on how the Trump regulatory freeze will impact the near term.

On Trump’s inauguration day, his Chief of Staff issued a memorandum instructing agencies to postpone pending rules and delay for 60 days published rules that had not yet taken effect. In its February 17 rule, CMS delayed the effective date of the Final EPM Rule to March 21, 2017. This change does not impact the July 1 implementation date for the cardiac bundles introduced by the Final EPM Rule or the expansion of CJR to additional care episodes. But it does delay the new CJR Track 1 –  (CEHRT).

CMS created this track of CJR, which requires the use of certified electronic health records technology and more than nominal financial risk, to qualify as an Advanced Alternative Payment Model (AAPM) under MACRA’s Quality Payment Program. This delay will make it harder for CJR clinicians to meet the payment and patient thresholds required to be an AAPM-qualified provider in the 2017 performance year and achieve the associated 5 percent bonus. Such clinicians would default to the Merit-based Incentive Payment System, but could take advantage of the reduced reporting requirements applicable in the 2017 transition year.

Bundles, MACRA and the Trump Regulatory Freeze