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How the ACA Repeal Impacts MU, MACRA and 21st Century Cures Act

Published on 2/1/2017

Last quarter’s news cycle was largely dominated by the election and events surrounding it. As such, reporting was comparatively light when it came to four significant regulatory and legislative actions with health IT implications. These are:

  • The 21st Century Cures Act, legislation to promote interoperability and address data blocking, as well as fund cancer research and opioid abuse treatment (December 2016)
  • The MACRA Quality Payment Program (QPP), implementing the Merit Incentive-based Payment System (MIPS) (November 2016)
  • The 2017 Outpatient Prospective Payment System (OPPS) that contained significant revisions for the EHR Incentive Program for 2017 and 2018 (November 2016)
  • Episode Payment Models (EPMs), which expand on the concept of geographically based mandatory episode based payment participation for hospitals

I’ve been working with federal health IT regulations since Meaningful Use began in 2011, and I’ve never experienced such a high volume of activity in such a short period, nor the resulting apprehension and uncertainty about the future. Under the Obama administration, we experienced significant payment reform, two examples being Episode Payment Model and Comprehensive Care for Joint Replacement Model. The future existence of these models, as well as the CMS Innovation Center that introduced them, is now in question. Fear, uncertainty and doubt can be painful. But it is important for all of us to remember some key truths.  

The rules released by CMS last quarter require an upgrade to the 2015 Certified EHR Technology (CEHRT) by Jan. 1, 2018. There are many reasons for this upgrade, but a key one is to advance the technology you use and the best practices you have in place to support increased interoperability. The upgrade and associated implementation, adoption, training and measuring will take anywhere from six to 12 months. You don’t have time to wait and see – we are already less than 12 months away from the January 1, 2018 deadline.

Right now, the big question for many is the executive order of President Trump regarding the repeal of the ACA. There is a common misconception that, should the ACA be repealed, those final rules will be reversed. This is not the case.  

The Affordable Care Act is separate from both Meaningful Use and MACRA. A repeal of ACA does not reverse requirements for MU and MACRA. On top of that, most payment reform is not within the ACA and therefore is not subject to the debate on what happens with repeal/replace. It’s also important to note that four major health-related statutes (PAMA, IMPACT Act, MACRA and 21st Century Cures) have all passed with strong bi-partisan support. Additionally, many federal lawmakers are big proponents of interoperability, so reversing the 2015 CEHRT requirement likely will not happen. 

On Jan. 20, the Trump Administration submitted a Presidential Memorandum enacting a regulatory freeze for recently finalized regulations. We’re closely watching to see if any rules subjected to this freeze affecting health or health IT will be pulled back. 

As with any administration change, it’s reasonable to feel somewhat uncertain about the future. As Cerner consultants, it’s our mission to help you minimize and mitigate risk created by this uncertainty. There will be a lot of new activity happening in 2017. To help prepare organizations for this turbulent regulatory landscape, Cerner Regulatory Compliance is hosting five 2017 Regulatory Alignment Summits over the next few months. We also post useful educational resources on the Regulatory Navigator to keep you up to speed. 

For any further guidance, don’t hesitate to reach out to us through your Cerner representative or through email at We’re here to help.