MACRA flexibility changes draw praise, but providers must move forward

Industry trade groups and experts are voicing approval of the announcement from the Centers for Medicare & Medicaid Services (CMS) that it would allow providers to choose the pace at which they comply with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

“The American College of Physicians (ACP) is pleased that CMS plans to implement changes to give physicians more options to participate in the Quality Payment Program in 2017 without being at risk of negative adjustments,” Nitan Damle, MD, president of the ACP, said in a written statement. “These changes are consistent with recommendations made by ACP and other physician stakeholders to exempt small practices from negative adjustments and to provide more flexible options for practices of all sizes to be successful.”

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Andrew Gurman, MD, president of the American Medical Association (AMA), issued similar praise. “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.

“The AMA believes the actions that the administration announced will help give physicians a fair shot in the first year of MACRA implementation,” Gurman added. “This is the flexibility that physicians were seeking all along.”

Helpful hints: 3 steps to get ready for MACRA

The flexibility comes in the form of four paths physicians can choose from:

·      Test the quality payment program. As long as a physician submits some data to the payment program, including data from after January 1, 2017, he or she will avoid a reimbursement cut. This option is designed to ensure the system is working and physicians are prepared for broader participation in 2018 and 2019, according to CMS.

·      Participate for part of the calendar year. Physicians can choose to submit quality data information for a limited period, so the first performance period could begin later than Jan. 1, 2017. According to CMS, if a physician submits information for part of the calendar year for quality measures, how the practice uses technology and any improvement activities the practice is undertaking, for example, he or she 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.

Next: It provides a little relief and time to prepare"

·      Participate for the full calendar year. Practices that are ready Jan. 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 reimbursement increase if they choose this option.

·      Participate in an Advanced APM in 2017. 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. Physicians who receive enough Medicare payments or see enough Medicare patients through the alternative payment model in 2017 would qualify for a 5% incentive payment in 2019.

Further reading: MACRA doesn't spell end of independent medical practices

“We weren’t surprised that there was some flexibility announced, but by the amount of flexibility,” says Ingrid Lund, PhD, practice manager for the Physician Practice Roundtable for the Advisory Board. “It provides a little relief and time to prepare. This is really welcome news for physicians.”

Lund says the majority of providers will fall into the first three options, which use merit-based payment. “I think we’ll see some progressive groups use the full performance year,” says Lund. “The best reward appears to come from the full year, and if you’re ahead of the pack and prepared to do it, that would make the most sense to do so.”

Providers should not mistake the flexibility for a delay in implementation, says Lund. Some data – the amount and type has yet to be defined – has to be submitted, so physicians need to keep working to prepare themselves for a full year of data submission.

Related: Tips for independent practices to survive value-based care

“You have to report something,” says Lund. “Ignoring it all together is not wise, because this is not a complete reprieve. There might be a few practices that just need a few more months to get ready and some that will be ready to report for part of the calendar year. It’s not explicitly stated in the announcement, but if you don’t report data, you can face a penalty.”

CMS is expected to release the final rule by November 1.