CMS finalizes MACRA payment system for doctors
October 17, 2016
by Thomas Dworetzky, Contributing Reporter
The massive Medicare Access and CHIP Reauthorization Act (MACRA) payment reform has been released and will ultimately change the way that more than 600,000 doctors and other health care professionals bill the government program for their services.
Its bonuses and penalties will change the way they practice medicine, too.
The new policies start Jan. 1, 2017.
“Designed with input from thousands of clinicians and patients across the country, the new Quality Payment Program will strengthen our health care system for patients, clinicians and the American taxpayer,” HHS Secretary Sylvia M. Burwell said in a statement.
The key goal is to pay for performance in the form of improved patient health outcomes and greater efficiency of resource use — and ultimately to reduce costs.
“A critical feature of the program will be implementing these changes at a pace and with options that clinicians choose,” Andy Slavitt, Acting Administrator of the Centers for Medicare & Medicaid Services (CMS), said.
He further noted in a blog post looking at the new changes, that overall, “other than a 0.5 percent fee schedule update in 2017 and 2018, there are very few changes when the program first begins in 2017. If you already participate in an Advanced Alternative Payment Model (APM), your participation stays the same. If you aren’t in an Advanced APM, but are interested, more options are becoming available. If you participate in the standard Medicare quality reporting and Electronic Health Records (EHR) incentive programs, you will find MIPS simpler. And if you see Medicare patients, but have never participated in a Medicare quality program, there are paths to choose from to get started.”
Calling the years it will take to transition “the first steps into a program that will continue to improve,” on a conference call with reporters, Slavitt stressed, "The bottom line is that we are trying to get doctors back to what they do best, care for patients, through a lot of simplification and support."
The earlier proposals for MACRA had raised concerns among many health care groups and professionals. In fact, there were over 4,000 comments sent to CMS and nearly 100,000 attendees at outreach sessions, which Slavitt said in the blog post represented “record levels of clinician engagement.”
Those looking closely at the new changes included the AMA, which applauded the way physician concerns were listened to.
"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,” noted the association in September, as HCB News reported at the time. “This approach better reflects the diversity of medical practices throughout the country.”
AMA noted in its statement to its membership about the recent MACRA announcement that it would “now pore over and dissect the final regulations in the coming days to make sure you know exactly what the rule contains and how it will impact your practice.”
The AMA Wire also noted that CMS “took physician input into consideration, announcing changes that will help physicians make the transition.”
Three changes included are:
When the payment scheme proposal was put forward in May, a JAMA commentary reported by HCB News at the time, by Dr. Jeffrey Clough of the Duke Clinical Research Institute and Dr. Mark McClellan, director of the Duke-Margolis Center for Health Policy, urged physicians to understand the changes — and opportunities — arising from the new payment scheme in the Medicare Access and CHIP Reauthorization Act (MACRA).
“Their leadership is essential to the future of high-value health care,” noted Clough.
Its bonuses and penalties will change the way they practice medicine, too.
The new policies start Jan. 1, 2017.
“Designed with input from thousands of clinicians and patients across the country, the new Quality Payment Program will strengthen our health care system for patients, clinicians and the American taxpayer,” HHS Secretary Sylvia M. Burwell said in a statement.
The key goal is to pay for performance in the form of improved patient health outcomes and greater efficiency of resource use — and ultimately to reduce costs.
“A critical feature of the program will be implementing these changes at a pace and with options that clinicians choose,” Andy Slavitt, Acting Administrator of the Centers for Medicare & Medicaid Services (CMS), said.
He further noted in a blog post looking at the new changes, that overall, “other than a 0.5 percent fee schedule update in 2017 and 2018, there are very few changes when the program first begins in 2017. If you already participate in an Advanced Alternative Payment Model (APM), your participation stays the same. If you aren’t in an Advanced APM, but are interested, more options are becoming available. If you participate in the standard Medicare quality reporting and Electronic Health Records (EHR) incentive programs, you will find MIPS simpler. And if you see Medicare patients, but have never participated in a Medicare quality program, there are paths to choose from to get started.”
Calling the years it will take to transition “the first steps into a program that will continue to improve,” on a conference call with reporters, Slavitt stressed, "The bottom line is that we are trying to get doctors back to what they do best, care for patients, through a lot of simplification and support."
The earlier proposals for MACRA had raised concerns among many health care groups and professionals. In fact, there were over 4,000 comments sent to CMS and nearly 100,000 attendees at outreach sessions, which Slavitt said in the blog post represented “record levels of clinician engagement.”
Those looking closely at the new changes included the AMA, which applauded the way physician concerns were listened to.
"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,” noted the association in September, as HCB News reported at the time. “This approach better reflects the diversity of medical practices throughout the country.”
AMA noted in its statement to its membership about the recent MACRA announcement that it would “now pore over and dissect the final regulations in the coming days to make sure you know exactly what the rule contains and how it will impact your practice.”
The AMA Wire also noted that CMS “took physician input into consideration, announcing changes that will help physicians make the transition.”
Three changes included are:
- There is no penalty, or negative payment adjustment, for physicians if “they choose one of four participation options in 2017. The takeaway: even minimal performance reporting will exempt you from any penalties, and opportunities for a shorter, 90-day reporting period will make you eligible for positive payment adjustments.”
- No reporting at all for low-volume practices that receive less than $30,000 in Medicare payments or have fewer than 100 Medicare patients.
- In the merit-based incentive payment system (MIPS), one of its four components, resource use, will have a 0 percent weighting toward MIPS score in the first year.
When the payment scheme proposal was put forward in May, a JAMA commentary reported by HCB News at the time, by Dr. Jeffrey Clough of the Duke Clinical Research Institute and Dr. Mark McClellan, director of the Duke-Margolis Center for Health Policy, urged physicians to understand the changes — and opportunities — arising from the new payment scheme in the Medicare Access and CHIP Reauthorization Act (MACRA).
“Their leadership is essential to the future of high-value health care,” noted Clough.