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CMS adds flexibility to its revised Medicare reimbursement program


Following feedback from physicians, The Centers for Medicare & Medicaid Services (CMS) announced Thursday it will allow providers to choose the level and pace at which they comply with the rules for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Following feedback from physicians, The Centers for Medicare & Medicaid Services (CMS) announced Thursday it will allow providers to choose the level and pace at which they comply with the rules for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).


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The change of heart comes after much criticism from physicians and healthcare industry leaders, who felt the start date of January 1, 2017 for doctors and practices to begin reporting quality data to CMS was too much too soon, according to CMS’ acting administrator, Andy Slavitt, who announced the flexibility in a blog post.

However, the announcement may not come as too much of a surprise, since MACRA co-author U.S. Rep. Phil Roe, MD (R-Tennessee) told Medical Economics in July he was pushing for at least a six-month delay in metric reporting by physicians.

“Universally, the clinician community wants a system that begins and ends with what’s right for the patient,” Slavitt wrote. “We heard from physicians and other clinicians on how technology can help with patient care and how excessive reporting can distract from patient care; how new programs like medical homes can be encouraged; and the unique issues facing small and rural non-hospital-based physicians.”


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According to the announcement, eligible physicians will be given four options to comply with the new payment methods for the first performance period that begins January 1, 2017, comprised of the Merit-based Incentive Payment System (MIPS) or an alternative payment model (APM).

Next: Breaking down the four options


“Choosing one of these options would ensure you do not receive a negative payment adjustment in 2019,” Slavitt wrote. “These options and other supporting details will be described fully in the final rule.”

The four options for practices are:

·       Test the Quality Payment Program

o   As long as a physician submits some data to the payment program, including data from after January 1, 2017, they will avoid a negative payment adjustment. This option is designed to ensure the system is working and physicians are prepared for broader participation in 2018 and 2019, Slavitt says.

·       Participate for part of the calendar year

o   Physicians can choose to submit quality data information for a limited period, so the first performance period could begin later than January 1, 2017. Slavitt explains that if a physician submits information for part of the calendar year for quality measures, how the practice uses technology and what improvement activities the practice is undertaking, for example, they could qualify for a small positive payment adjustment. Physicians can select from the list of quality measures and improvement activities available under the payment program.


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·       Participate for the full calendar year

o   Practices that are ready on January 1, 2017 can choose to submit information for the full calendar year. This means the first performance period would begin on the first day of the year. Practices could qualify for a modest positive payment adjustment if they choose this option.

·       Participate in an Advanced APM in 2017

o   Instead of reporting quality data and other information, the law allows physicians to participate in the payment program by joining an Advanced Alternative Payment Model, such as Medicare Shared Savings Track 2 or 3 next year. If a physician receives enough Medicare payments or sees enough Medicare patients through the alternative payment model in 2017, then they would quality for a 5% incentive payment in 2019.



Next: "We will have resources available"


“However, you choose to participate in 2017, we will have resources available to assist you and walk you through what needs to be done,” Slavitt wrote. “And however you choose to participate, your feedback will be invaluable to building this program for the long term to achieve outcomes that matter to your patients.”


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What do you think of this announcement from CMS?  Does it adequately address physician concerns?  Tell us at

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