CMS' recent announcement that they will ease up reporting requirements for providers in the first year of compliance under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was met with muted applause from the provider community.
Make no mistake about it, groups like the Medical Group Management Association (MGMA) and AMA are happy CMS is giving providers the ability to avoid a negative payment adjustment under MACRA by simply testing their system. However, they emphasize that more needs to be done to the quality payment program to make overall compliance an obtainable goal for doctors.
In other words, says Anders Gilberg, senior vice president of government affairs for MGMA, the final rule of MACRA implementation needs to be significantly less arduous for physicians than the proposed rule. Otherwise, "if not much has changed [from the proposed rule to the final rule], then all they are doing here is delaying a flawed program," he says.
Under the original guidance, complying with either of MACRA's two payment paths — the Merit-Based Incentive Payment System (MIPS) or Alternative Payment Models (APM) — for the entirety of 2017 would have a positive or negative effect on physicians' Medicare reimbursement rates in 2019. Many in the physician community were disturbed by this because it only gives them a few months to prepare for new reporting requirements that start Jan. 1, 2017. (The final rule is projected to be announced sometime in late October or early November 2016.)
According to CMS' latest blog, providers can now "pick their pace" and choose one of four potential options to ensure they do not receive a negative payment adjustment in 2019. Most notably, the "test" option says as long as they submit some data to the quality payment program during the next year, they will avoid a negative payment adjustment. They can also attempt to receive a positive payment adjustment for MACRA compliance if they participate in the full program (for either part of the year or the full year), or through an advanced APM.
"I think it will allow us to succeed and to comply," says Andrew Gurman, an orthopedic hand surgeon from Hollidaysburg, Penn., and president of the AMA. "We have always said we want doctors to succeed and we want MACRA to succeed. We've said…if all this happens on Jan. 1, [MACRA] is potentially a recipe for disaster and failure…Waiting to see the final rule…it gives us the opportunity to do partial year reporting or do the test option and avoid the penalty. It's a very positive step."
The key word there is step. Gurman's AMA submitted 94 pages worth of comments and recommendations on the proposed rule. One of the important requests, he says, is to institute special accommodations for small and rural practices, such as giving those with low Medicare volumes an exemption from the program. He also said he'd like more consolidation among the four MIPS categories, a removal of the pass/fail elements of the categories, better detail on pathways from MIPS to APM participation, and an expansion of eligible alternative payment models.
Easier entry and compliance through alternative payment models is something Gilberg at MGMA would also like to see changed from the proposed rule as well. "The definition is far too narrow in the proposed rule," he says. "In order for this to really work, we expect the final rule to include [more ways to comply through an] alternative payment model."
Gilberg would also like to see a removal of the two-year lookback approach that CMS has used in the past. He says there is a disconnect between the performance year and the year when the incentives take place. "The disconnect is so great it doesn't provide for actionable feedback to clinicians to improve patient care," he says, noting that without that actionable feedback, this becomes just another compliance program, rather than something meant to actually improve patient care.
Despite these reservations, Gilberg — and Gurman for that matter — were positive about the direction CMS was headed with MACRA and hopeful about the final rule. Both say these changes are a credit to CMS Acting Administrator, Andrew Slavitt, who has been very open to listening to physicians' concerns about MACRA and other federal government compliance programs.
Experts say that even with the recently instituted flexibility, providers cannot afford to be complacent in MACRA compliance. "This an opportunity for docs to think about how they want to do this," says John David Goodson, staff internist at Mass General Hospital and associate professor at Harvard Medical School. Goodson, who recently talked to Physicians Practice on the Pearls podcast about MACRA compliance, said that providers should take time once the final rule is out to sit down and figure out the best way to handle compliance.
"Small practices shouldn't be intimidated by the new world of MACRA," Goodson says. "They may be better off than large enterprises. They have good relationships to depend on in their communities and can track [patient outcomes] better."