The statement made by Acting Administrator of the federal Centers for Medicare & Medicaid Services (CMS) Andy Slavitt last week, healthcare association advocacy leaders shared with Healthcare Informatics their perspectives on what might happen next, as some elements mandated by the MACRA (Medicare Access and CHIP Reauthorization Act of 2015) come closer to being put into place. As HCI Managing Editor Rajiv Leventhal noted in his July 13 report, Slavitt made a statement during the U.S. Senate Finance Committee’s hearing that day in which he hinted broadly that there might be flexibility around the January 1, 2017 start date that otherwise was expected to be set into motion around physician reporting requirements.
As Leventhal noted in his report, “The Congressional hearing, led by Committee Chairman Orrin Hatch (R-UT) and Ranking Member Ron Wyden (D-OR), set out to give Slavitt a chance to describe MACRA’s implementation efforts and give members of Congress a chance to address issues and concerns towards the CMS head. Hatch opened his statement by noting that physicians are greatly concerned about the timeline of MACRA, which as currently scheduled, calls for implementation to begin in 2017 with bonuses being paid out to eligible Medicare doctors in 2019. Indeed, as comments from healthcare stakeholders poured in since the release of the proposed MACRA rule in April, various physician groups have called for a host of greater flexibilities, many which center around pushing the start date back at least six months.”
During the course of the hearing, Leventhal noted, “Hatch stated that the MACRA law gives CMS the flexibility to move the start date of the reporting period back.” He quoted Sen. Hatch as saying that “Physicians are concerned about the timeline. If CMS releases the final rules around Nov. 1, that only leaves two months for them to prepare. It’s a legit concern.” In response, our report noted, “Slavitt agreed with Hatch, responding that the program needs to be launched ‘so it begins on the right foot, so every physician in the country feels that they are set up for success.’ He added, ‘There has been significant feedback received here, and we remain open to options including alternative start dates, looking at shorter [reporting] periods used, and other ways physicians could get help and experience before the program hits them.’”
Complexities around timing
There are a number of complexities inherent in the current situation in this moment, says Leslie Kriegstein, vice president of congressional affairs at the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME). To begin with, the Washington, D.C.-based Kriegstein says, the timing of the release of the final rule for this implementation is expected to be sometime in October, or at the very latest, early November; and that would give physicians and organizations with physicians very little time to put into place the information technology and data and reporting systems needed to ensure that they could begin reporting a broad array of data points to CMS beginning on Jan. 1, as was written into the MACRA legislation.
Fundamentally, Kriegstein says, there are two essential possibilities here. “They could change either the start date or the reporting period. The only reporting period proposed explicitly in the legislation was for clinical practice improvement, which carried a 90-day proposal” in the enabling legislation, she notes. Kriegstein who was present at the Finance Committee hearing last week, said, “Acting Administrator Slavitt said, we want to launch this program on the right foot, for clinician success, which might therefore involve alternate start dates, or shortened reporting periods.” Asked what she thinks might happen, she says, “I could see a scenario where CMS clearly has the propensity to leverage shortened reporting periods for program years they think will be challenging, so I could see that as probably the greatest possibility. Last month, the AMA [American Medical Association] came out asking for a delay; some other groups asked for a July 1 start date.”
Asked whether in practice there is a difference between postponing the start date or shortening the reporting period in 2017, Kriegstein says, “In practice, they end up being the same thing. For example, per meaningful use, or in the hospital quality reporting program, they give you quarters to pick from. So it’s possible that they could change the reporting period to 90 days or 120 days, with some flexibility around the length or the start date.”
Jeffrey Smith, vice president of public policy at the Bethesda, Md.-based American Medical Informatics Associations (AMIA), says, “CMS doesn’t usually telegraph what they’re going to do in relation to timing, until the last minute. If you look at meaningful use and the 90-day reporting period, they waited until the last moment to make that announcement,” he says. “I think that Andy Slavitt’s words were really encouraging to providers who felt that this would be a really heavy lift for individuals and organizations. And frankly, I haven’t spoken to any individual or organization that thought that January 1 would be a realistic timeframe.”