Medical associations and experts have noted that performance reporting will be a burden on small practices under Medicare’s new Merit-based Incentive Payment System (MIPS), a value-based payment program that began on January 1.
To help small practices with this reporting next year, the government has promised to create “virtual groups”—electronically connected networks of independent physicians that can use the group’s health IT infrastructure to report performance data on their eligible clinicians. Each group will include between two and 10 eligible clinicians, according to the Centers for Medicare & Medicare Services (CMS).
Last fall’s final rule for the Medicare
Access and CHIP Reauthorization Act of 2015 (MACRA) created MIPS and authorized virtual groups, but details regarding the latter were scant. CMS officials say future rulemaking will explain it all.
So we don’t yet know whether the groups will consist of physicians located in the same geographic area, where the funds will come from to build the groups’ technical infrastructure, or how they will help practices collect the requisite data.
Here’s what we do know about virtual groups and how physicians can use organizations outside their practice to report performance data.
CMS has decided not to implement virtual groups in 2017, which the agency regards as a “transition year” for physicians.
In the executive summary of the MACRA final rule, CMS said it needed more information from stakeholders on how to structure and implement virtual groups. The agency also notes in the body of the rule that it has “identified significant barriers regarding the development of a technological infrastructure required for successful implementation.”
CMS has invited comments on minimum standards for members of virtual groups, how these networks could use their data for analytic purposes, the use of group identifiers and “requirements that could facilitate use of virtual groups to enhance health outcomes and goals such as coordination of care.”
The latter goal suggests that CMS has plans for virtual groups that extend beyond group reporting by independent practices. But before agency officials write rules, they want to make sure they understand all the ramifications of its proposal, says Billy Wynne, JD, who heads the health policy division of Thorn Run Partners, a Washington, D.C., lobbying firm.
“CMS has been burned by tech barriers in healthcare.gov, so they’re being extra cautious before they green-light this mechanism,” Wynne says. “But CMS is also concerned about the ability of small practices to succeed under MIPS. So they want to get virtual groups out there, but want to make sure they do it right.”