Responding to industry feedback to its proposed Medicare Access and CHIP Reauthorization Act (MACRA) rule from April, the Centers for Medicare & Medicaid Services (CMS) announced on Sept. 8 that it will allow physicians to pick their pace of participation for the first performance period that begins Jan. 1, 2017.
In a blog post, CMS Acting Administrator Andy Slavitt wrote that during 2017, “eligible physicians and other clinicians will have multiple options for participation. Choosing one of these options would ensure you do not receive a negative payment adjustment in 2019. These options and other supporting details will be described fully in the final rule.” Slavitt said the final rule will be published before November 1. This summer, Slavitt himself left open the possibility that the sweeping changes set to overhaul physician payment as the healthcare industry shifts to paying doctors for value rather than volume, could be pushed back from the intended start date of Jan. 1.
But now, according to CMS’ most recent MACRA update, eligible Medicare physicians will be given four options for participation in the first year of the outcomes-based program, still set to begin in January. The first option is to “test” the Quality Payment Program, which includes two paths—the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). Under this first option, as long as physicians “submit some data to the Quality Payment Program, including data from after Jan. 1, 2017,” they will avoid a negative payment adjustment.” The idea of this option is to ensure that systems are working and that providers are prepared for broader participation in 2018 and 2019 as knowledge is gained.
The second option is to choose to submit Quality Payment Program information for a reduced number of days. This means that the first performance period could begin later than Jan. 1, 2017 and the physician’s practice could still qualify for a small positive payment adjustment. Slavitt writes, “For example, if you submit information for part of the calendar year for quality measures, how your practice uses technology, and what improvement activities your practice is undertaking, you could qualify for a small positive payment adjustment. You could select from the list of quality measures and improvement activities available under the Quality Payment Program.”
The third option is to participate for the full calendar year in 2017. This choice is for practices that are ready to go. CMS said that it has “seen physician practices of all sizes successfully submit a full year’s quality data, and expect many will be ready to do so.”
The fourth option is to participate in an Advanced Alternative Payment Model in 2017. Examples of this include Medicare Shared Savings Track 2 or 3 in 2017. Slavitt writes, “If you receive enough of your Medicare payments or see enough of your Medicare patients through the Advanced Alternative Payment Model in 2017, then you would qualify for a 5 percent incentive payment in 2019.” It should be noted that most policy experts predict eligible physicians to initially pursue MIPS because an APM that qualifies under MACRA will bring with it a significant amount of risk.
Just this week, Congressional leaders wrote a letter to the U.S. Department of Health and Human Services (HHS), asking for flexibilities within the MACRA law. Two main causes of concern for eligible physicians were the effect MACRA would have on small practices and the short window that participants will have from the release of the final rule to the scheduled Jan. 1, 2017 start. Indeed, a Black Book survey from June revealed that two-thirds of high Medicare-volume doctors foresee the end of their independence due to the physician payment changes that will take place under MACRA.
Slavitt said in his blog post that to these ends, the federal agency has talked to thousands of physicians and clinicians across the country. “Universally, the clinician community wants a system that begins and ends with what’s right for the patient,” he 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. We will address these areas and the many other comments we received when we release the final rule by November 1, 2016.”