MACRA: CMS will give docs 4 options for 2017 -AND- New MACRA Rules Make Medicare Pay Cut in 2019 Less Likely

CAL/AAEM News Service at
Sun Oct 2 19:54:22 PDT 2016



September 8, 2016


MACRA: CMS will give docs 4 options for 2017



k0RnZaMEZnazlXWDFRVG9BPSJ9> Fierce Healthcare



By Ilene MacDonald


Bowing under industry pressure, the Centers for Medicare & Medicaid Services
announced Thursday it would ease the implementation of the Medicare Access
and CHIP Reauthorization Act of 2015 (MACRA), set to take effect on Jan. 1,


MACRA changes how CMS pays practices that provide care to Medicare
beneficiaries, placing emphasis on quality care and improved patient
outcomes. Physicians can take part via the Merit-based Incentive Payment
System (MIPS), or an alternative payment model.

Physician practices will now have four options in order to "pick their pace"
to comply with the new Medicare payment reform system, according to Andy
Slavitt, acting administrator of CMS.


Option 1: As long as physician practices submit some data to the quality
payment plan (including data from after Jan. 1, 2017), they will avoid a
negative payment adjustment. This option will allow practices to "test"
their systems and show CMS that it works and the practice is prepared for
broader participation in 2018 and 2019.


Option 2: Submit data for part of the calendar year. Practices can still
qualify for a small positive payment adjustment, even if the data for their
first performance period begins after Jan. 1. This data would include
quality measures, how your practice uses technology and quality improvement


Option 3: For practices that are already prepared for MACRA on Jan. 1, they
can submit data for a full calendar year and could quality for a modest
positive payment adjustment. "We've seen physician practices of all sizes
successfully submit a full year's quality data, and expect many will be
ready to do so," Slavitt said.


Option 4: Participate in an advanced alternative payment model, such as
Medicare Shared Savings Track 2 or 3 in 2017. Practices that receive enough
Medicare payments or see enough Medicare patients through the model could
qualify for a 5 percent incentive payment in 2019.


Slavitt said more details on all the options will be provided in the final
rule, which will be released by Nov. 1.


"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
said. "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."


The decision to give physicians more flexibility came as welcome news to
Congressman Rep. Michael Burgess (R-Texas). In a statement to the press,
Burgess, a trained obstetrician, said he was committed to leading the charge
for continued Congressional oversight of the process to ensure "simplified,
streamlined requirements that allow for all doctors to succeed."


Blair Childs, senior vice president of public affairs, for Premier, Inc.,
said in a statement that the alliance appreciates the direction CMS has
given providers prior to the release of the final rule. But he hopes CMS
will also listen to providers and reduce the level of risks for advanced
alternative payment models and take steps to create more ACO tracks to
provide additional opportunities for eligible clinicians to obtain the
percent incentive payment.




September 8, 2016


New MACRA Rules Make Medicare Pay Cut in 2019 Less Likely 



t_160908_MSCPEDIT&uac=116715AZ&impID=1193851&faf=1> Medscape



By Robert Lowes


Under pressure from organized medicine, the Medicare program has drastically
simplified what physicians need to do next year to avoid a penalty in 2019
under the Medicare Access and CHIP Reauthorization Act (MACRA).


The 2015 law created a complicated framework called the Quality Payment
Program (QPP) that shifts reimbursement from fee-for-service (FFS) to
pay-for-performance. The new system debuts in 2017, and how physicians
perform then will determine whether they earn bonuses or penalties 2 years
down the line.


The Centers for Medicare & Medicaid Services (CMS) issued its proposed
regulations for MACRA in April, and the final version won't surface until
October or November. Fearing that their members wouldn't have enough time to
master the rules by January, the American Medical Association (AMA), the
American College of Physicians, the American Academy of Family Physicians,
and other societies asked the government to delay the kick-off until July


Medicare isn't delaying the new payment system outright, but it promises to
do something close to that. Today, CMS acting administrator Andy Slavitt
announced in his blog that his agency would give physicians four MACRA
options for 2017 that would let them pick their own pace of implementation -
a very slow pace, if they choose. And each one would steer clear of a
penalty in 2019.


Physicians Can Merely "Test" the New System Next Year


The options play off two reimbursement tracks in the QPP. The default track
that initially will encompass the vast majority of physicians is the
Merit-Based Incentive Payment System (MIPS). It combines three existing
pay-for-performance incentive programs: meaningful use of electronic health
records (EHRs), the Value-Based Payment Modifier, and the Physician Quality
Reporting System (PQRS). Physicians will receive a bonus or penalty based on
their composite score across the performance categories of quality of care,
cost of care, clinical practice improvement, and meaningful use of EHRs, now
called advancing care information.


In 2019, MIPS bonuses and penalties will be as high - or low - as 4% percent
of Medicare FFS revenue and increase to 9% in 2022 and beyond. CMS initially
estimated that most physicians in groups of 24 or less in MIPS would incur a
penalty, but qualified the projection as a bit fuzzy.


The Advanced Alternative Payment Models (Advanced APMs) is the other payment
track for physicians. These APMs earn a lump sum bonus of 5% a year as long
as they assume serious financial risk under their particular model. Examples
of Advanced APMs include next-generation accountable care organizations,
Comprehensive Primary Care Plus, and track 3 of the Medicare Shared Savings
Program. Physicians participating in Advanced APMs are exempt from MIPS and
its penalties.


The first MACRA option announced by Slavitt today, an option dubbed "test
the QPP," allows physicians in MIPS to avoid the 2019 penalty by merely
reporting some quality and cost data - "some" is undefined for now - in
2017. Slavitt wrote that this option "is designed to ensure that your system
is working and that you are prepared for broader participation in 2018 and
2019 as you learn more."


Under the second option, physicians in MIPS can submit quality and cost data
for just part of 2017, and the performance period could begin later than
January 1. Besides avoiding a penalty, these physicians could qualify for a
small bonus in 2019.


Submitting performance data for the full calendar year in 2017 is the third
option, and Slavitt expects that many practices will be able to do this


The fourth option is to join an Advanced APM, which, like the third option,
has been available to physicians all along.


Slavitt said that the final regulations for MACRA will flesh out the details
of the agency's "pick your pace" plan.


In a news release today, AMA president Andrew Gurman, MD, said that his
group "strongly applauded" the government for listening to physicians'
concerns about the timetable originally proposed for MACRA and adopting a
"thoughtful and flexible approach."


"The AMA believes the actions that the administration announced today will
help give physicians a fair shot in the first year of MACRA implementation,"
said Dr Gurman. "This is the flexibility that physicians were seeking all




Jeff Wells
Deputy Editor, CAL/AAEM News Service


Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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