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MACRA Final Rule Eases Pay Changes, Initially

By Debra Shute  
   October 17, 2016

In response to clinician feedback, CMS has outlined a more gradual payment transformation intended to evolve over years to come. Physicians and major medical groups are responding with guarded optimism.

In the months leading up to the final rule, clinicians and healthcare organizations spoke out forcefully about their concerns about MACRA. With the release of its 2,398-page final rule on Friday, Centers for Medicare & Medicaid Services (CMS) officials appear to have heard them.

The feedback CMS received through scores of written and face-to-face comments can be summed up as a plea to make clinicians' and practices' transition to its new payment system as simple and flexible as possible, Acting Administrator Andy Slavitt said during a press briefing Friday.

MACRA Payment Reforms Finalized

"Ultimately, we're not looking to transform the Medicare program in 2017," he continued. "We're looking to make a long-term program successful," Slavitt said.

Not Revenue-Neutral
A significant clarification provided during CMS's briefing on Friday is that MACRA is not a revenue-neutral program. "It has some revenue-neutral features, but it has additional elements," said Slavitt. Those items include the 0.5% positive payment adjustment across the board, a 5% bonus for advanced APMs in addition to earned quality dollars, and a total $5 million in bonuses for top performers in the MIPS program.

The only clinicians who should receive a negative adjustment in 2017 are those who are not exempt but choose not to submit any data to CMS, stated Slavitt. "We have an extensive effort [underway] to educate, inform, and reach out to physicians who may not have heard about MACRA or not heard much about MACRA to keep that to a minimum."

Nonetheless, it appears that the bonuses will come out of the penalty pool, notes Joel Brill, MD, chief medical officer for Predictive Health, LLC, in Paradise Valley, AZ. "It's a zero-sum game," he says.

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.

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