MACRA “pick-a-pace” approach a step in right direction, docs say

After going silent for most of the summer, the MACRA world finally began making some noise in September. And for some physicians, it was music to their ears.

Acting CMS Administrator Andy Slavitt, via a blog post, announced the ambitious new law would opt for what amounts to a soft rollout in 2017 – not the full-blown start that some physicians, and advocacy groups that represent them, complained was too aggressive a timeline. CMS isn’t expected to release final MACRA regulations until sometime this fall, which would leave physicians and other eligible professionals (EPs) with just a few weeks to digest the law before they would need to start reporting performance data – data that could result in Medicare payment cuts.

The new plan isn’t the outright delay that some small practices and groups, such as the American Medical Association (AMA) and Medical Group Management Association (MGMA), requested, but it appears it will be enough of a reprieve to allay concerns that EPs wouldn’t have enough time to prepare adequately for MACRA.

A quick refresher: MACRA includes the Quality Payment Program (QPP), which establishes a new formula for determining how EPs are paid for the care they provide to Medicare patients. Most EPs in individual and small-group practices will participate in the Merit-Based Incentive Payment System (MIPS) portion of MACRA. EPs may also choose to join an Advanced Payment Model (APM), such as Medicare Shared Savings Track 2 or 3.

The proposed MACRA regulations CMS released in the spring called for assessing EPs with a +/- 4% payment adjustment based on MIPS data they reported in 2017. That adjustment would be assessed in 2019.

Under the new plan, it will be much easier to avoid getting stuck with a negative payment adjustment in 2019. However, MACRA still technically begin in January and physicians will still be able report data as originally planned.

In place of straight-up MACRA launch in January, EPs may choose from one of four options. The big takeaway is none will generate a negative payment adjustment. To avoid a penalty, EPs need only submit some data to the QPP in 2017. This option is designed to allow EPs to test the system and be prepared to use in fully in 2018 and 2019. Other options include reporting actual MIPS data for part of the year, or reporting a full year’s worth. The latter two options will make EPs eligible for a modest positive payment adjustment. As noted earlier in this post, EPs may also choose to join an APM, qualifying them for a 5 percent incentive payment.

Groups such as the AMA and MGMA view CMS’s solution as a temporary fix, albeit a welcome one. The proposed MACRA regulations released in the spring generated thousands of comments to CMS from across the health care industry. So MACRA may be a work in progress, but Acting Administrator Slavitt said in his blog post that CMS expects plenty of physicians are ready to submit – and will submit – a full year’s worth of data next year.

Stay tuned.

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