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MACRA: Physician Groups Praise Flexible Reporting Options

Analysis  |  By Christopher Cheney  
   September 12, 2016

CMS is giving medical doctors four "pick-your-pace" reporting options while ensuring that they do not receive a negative payment adjustment in 2019.

Physician groups are praising last week's announcement delaying the reporting requirements established under the Medicare Access and CHIP Reauthorization Act (MACRA).

Prior to last week's announcement, physicians were facing full implementation of the of the value-based payment system for Medicare reimbursement under MACRA starting Jan. 1, 2017. The reporting requirements are considered onerous by many, and providers and payers pressed Medicare for postponement over the summer.

In Thursday's announcement, the Centers for Medicare & Medicaid Services granted physicians four "pick-your-pace" options to comply with MACRA's reporting requirements next year.

"By adopting this thoughtful and flexible approach, the Administration is encouraging a successful transition to the new law by offering physicians options for participating in MACRA. This approach better reflects the diversity of medical practices throughout the country," Andrew Gurman, MD, president of the Chicago-based American Medical Association, said in a prepared statement Thursday.

4 Pick-Your-Pace Options
In Thursday's announcement, CMS gave physicians four options to meet the reporting requirements for the MIPS performance categories next year and ensure that they do not receive a negative payment adjustment in 2019:

  1. Submitting enough data to the Quality Payment Program "to ensure that your system is working and that you are prepared for broader participation in 2018 and 2019."
  2. Submitting the full set of performance data for less than the full 2017 calendar year.
  3. Submitting the full set of performance data for the full 2017 calendar year.
  4. Participating in an Advanced APM in 2017.

Nitin Damle, MD, FACP, president of the Philadelphia-based American College of Physicians, says granting flexibility in the reporting requirements will help physicians chart the best financial course for their practices as the new payment system is implemented.

MACRA, the End of Meaningful Use, and Beyond

"The minimal reporting option will also allow for a longer transition period for those practices that still need time to adjust for the new MACRA performance requirements without being at risk of negative adjustments, while other practices that are able to more fully participate in 2017, for some or all of the year, could qualify for 'small' to 'modest' positive adjustments," Damle said in a statement issued Friday.

Although CMS has delayed the reporting requirement for the Quality Payment Program, a key takeaway point from Thursday's announcement is that Medicare's new payment system for physicians will likely launch as planned in 2019, Harold Miller, president and CEO of the Pittsburgh-based Center for Healthcare Quality and Payment Reform, told HealthLeaders on Friday.

"This is not delaying implementation of MACRA, it's actually creating a less problematic starting point for the measurement that will go into determining what happens to physicians in 2019."

The reimbursement provisions of MACRA, which CMS have dubbed the "Quality Payment Program," establish two value-based payment pathways for physicians who provide services to Medicare beneficiaries:

  • The Merit-based Payment Incentive System (MIPS) and
  • Advanced Alternative Payment Models (Advanced APMs)

When the new payment system launches in 2019, most physicians are expected to receive Medicare payments through MIPS, which has four performance categories:

  • Quality,
  • Cost,
  • Clinical care improvement activities such as boosting care coordination, and
  • Electronic health record capabilities

The 2017 proposed rule for the Quality Payment Program sets criteria for Advanced APMs but names only a handful of existing CMS APMs that would qualify under the new payment system, including Next Generation ACO and Comprehensive Primary Care Plus.

The 2017 final rule for the Medicare physician-payment provisions of MACRA is expected to be released by Nov. 1.

Christopher Cheney is the CMO editor at HealthLeaders.

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