MACRA Final Rule Draws Mixed Reactions

Debra Shute, November 6, 2017

AMGA, ACP, and CAPG note plusses and minuses of the final MACRA rule; groups optimistic that CMS will listen to their concerns.

The Centers for Medicare & Medicaid Services (CMS) released its final rule for the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs) under the Medicare Access and CHIP Reauthorization Act (MACRA) on November 2, and doctors' groups have responded with mixed reviews.

A key change announced by CMS—increasing the threshold for participation in its Quality Payment Program (QPP) to $90,000 in Medicare Part B total allowed charges or 200 Medicare Patient Encounters—means that an additional 123,000 clinicians needn't be concerned with the QPP in 2018 and beyond.

While CMS states that the change is intended to promote greater flexibility, the American Medical Group Association (AMGA) expressed concern that the final rule excessively shies away from value-based care.

“The transition to value is challenging and CMS understandably wants to ease providers into value,” said Jerry Penso, MD, M.A, AMGA president and CEO.

“But excluding providers isn’t the same as learning how to deliver care in a value-based world. Taking accountability for the quality and cost of care requires years of experience. Despite CMS’ intentions to ensure a smooth transition, AMGA is concerned that this rule actually hinders the prospects for value-based care.”

Related: MedPAC Debates Best Way to Replace MIPS

Meanwhile, AMGA and CAPG, a professional association for accountable physician groups, applauded CMS' decision to proceed with designing and implementing a Medicare Advantage APM under the QPP.

“We look forward to working with CMS to design and implement this demonstration in a timely fashion, said Donald H. Crane, CAPG president and CEO. "We know that this decision will accelerate the movement from volume to value.”

In addition, the American College of Physicians (ACP) said it was pleased with much of the rule, especially CMS’ new policy to allow clinicians who are impacted by extreme and uncontrollable circumstances to be provided relief from reporting requirements associated with QPP in 2017 and 2018.

The APC did note some concerns about several of the provisions of the rule, however.

In particular, some of the provisions are inconsistent with recently announced CMS initiatives on “Patients Over Paperwork” and “Meaningful Measures,” said Susan Thompson Hingle, MD, MACP, ACP Board of Regents chair.

“In light of the recent announcement we are encouraged that CMS will follow through and address our concerns,” Hingle concluded.

Stakeholders have until January 1, 2018, to submit their comments on the final rule to CMS.

Debra Shute

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.

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