When the senior officials of the Centers for Medicare and Medicaid Services (CMS) released the final rule around the MACRA (Medicare Access and CHIP Reauthorization Act of 2015) law, including for its component MIPS (Merit-based Incentive Payment System), on October 14, that action has generated a great deal of analysis and commentary in the healthcare professional press, including by Healthcare Informatics Senior Contributing Editor David Raths.
In the month since the publication of the MACRA final rule, the editors of Healthcare Informatics have interviewed a number of industry experts about it. Recently, Editor-in-Chief Mark Hagland interviewed Mara McDermott, a Washington, D.C.-based attorney and the vice president of federal affairs at the Los Angeles-based CAPG, about the final rule and its impact on healthcare providers. CAPG, which describes itself as “the voice of accountable physician groups,” is a national association of nearly 300 medical groups and independent practice associations (IPAs) involved in accountable care organization (ACO) development and other risk-based contracts, across 41 states. Below are excerpts from that interview.
What are the most important features of the final MACRA rule, in your view?
What we see in the final rule is that CMS has really tried to strike a balance for physicians who are new to MACRA, to create a soft landing for the first year of MACRA implementation; that’s number one. Number two, we see a framework in the final rule for MACRA to ramp up over time. So there’s this immediate softening and flexibility for physicians, along with some of CMS’s intentions for MACRA in the future.
How would you describe those?
We see a pretty low initial bar for MIPS, in terms of its scaling back on the number of measures to report on, in order to avoid a penalty—in order to help physicians get familiar with MACRA and MIPS, to figure it out. One of the questions we have is, is there some burden on physicians before MACRA takes effect? Under current law, before the MACRA performance period of 2017, physicians are participating in PQRS [the Physician Quality Reporting System], the value-based payment modifier program, and Stage 3 of meaningful use; and each of those programs has reporting and data collection requirements associated it that is more than what’s required under MACRA in 2017 to avoid a penalty. We’ve been thinking about that a lot. For the 2016 4eporting period, physicians still need to do that reporting, and it will impact their payment in 2018 before MACRA takes effect. So that’s something we’ve been kicking around a bit to figure out, what the application of those programs looks like for the 2017 and 2018 payment years, before the 2019 first year of MACRA payment.
What are your biggest concerns about MACRA and MIPS?
CAPG has come at this looking at the advanced payment model [APM] options. I know you’ve spoken to Don Crane. One of the things we’ve been concerned about is achieving a reasonable balance between a framework that is functional for MACRA and MIPS, on the one hand—balancing meaningful measurement in MIPS and moving folks along the continuum from FFS to advanced alternative payment models. So what does MIPS need to look like to prepare physicians to move into advanced APMs? What are the things you can do in MIPS to move folks into a CPC-Plus or Next-Generation ACO, and to move to those forms of payment that are alternative to fee-for-service payment?
One of the biggest issues is the treatment of Medicare Advantage: many of our members take risk downstream in Medicare Advantage. CMS pays the health plans capitation under MA, and then the plans can choose how to pay the physicians. And many of our physicians are in risk-based contracts with plans. They’re taking on risk to provide care for populations of patients. And we’ve argued that that type of risk, where you’re having a physician taking risk under a plan, should be afforded the same credit as working under MACRA. There won’t be any credit under the first two years under MACRA for physicians taking on risk through health plans.
Is there any possibility that CMS could alter that, under the terms of MACRA?
We’ve been trying to encourage CMS to count or somehow give credit for those relationships. We’re also working with Congress on a piece of legislation to afford credit for those contracts under Medicare Advantage.
Might that legislation be introduced soon?
We hope so. There’s sensitivity, because MACRA was passed in such a huge bipartisan fashion, and if you reopen it, could that cause the flood gates to open?
Do you believe that the number and rigor of data points to be reported under MIPS, will be increased over time?
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