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Report: MACRA 2018 Rule Under Review as Tom Price Looks to Relieve Docs

April 27, 2017
by Rajiv Leventhal
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Could more MACRA relief be on the way for Medicare clinicians?

The Trump administration is currently reviewing potential 2018 updates to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that would especially ease the burden the new legislation puts on small physician practices, according to a report this week in The Hill.

According to the report, doctors are holding out hope that federal leaders will reduce the reporting burdens for smaller physician practices that currently exist under the Merit-based Incentive Payment System (MIPS), and will also look for ways for more clinicians to participate in advanced alternative payment models (APMs). MIPS and APMs are the two payment paths under MACRA’s Quality Payment Program for which the government will determine payment adjustments for eligible Medicare clinicians.

It should be comforting to physicians that new Health and Human Services Secretary Tom Price, M.D., is an orthopedic surgeon who has shared the concerns that small and solo doctors have regarding MACRA’s impact on their businesses. Technically, the first reporting period of the Quality Payment Program kicked off in January, but previous federal officials under the Obama Administration dubbed 2017 as a “transition year,” meaning that as long as Medicare doctors did at least the minimum reporting, they wouldn’t get dinged with negative payment adjustments. It’s expected that Price will extend that flexibility. In fact, Peter Fise, a senior policy analyst with the Bipartisan Policy Center, told The Hill that it’s a “pretty sure bet.” The proposed rule from Price is expected to drop in the coming weeks, if not sooner.

Currently, the Centers for Medicare & Medicaid Services (CMS) has said that just 11 alternative payment model initiatives will count as eligible APMs for MACRA this year. This means that the overwhelming majority of Medicare doctors will be in the MIPS track early on in the program. Some 10 percent of participating clinicians are expected to be in the APM track this year, though CMS has said that it expects that number to rise to 25 percent by 2018.

Since the MACRA final rule came out in October 2016, and even before that, there has also been no shortage of surveys and reports that have revealed a lack of readiness on the part of clinicians. Healthcare Informatics ran its own excusive survey with SERMO last month which found that just one in five practices (20 percent) with 15 physicians or fewer and approximately one in four practices (28 percent) with 16 to 50 physicians report that they are “ready to go” to meet the core requirements under MACRA.

This week, the American Academy of Family Physicians (AAFP) sent a letter to CMS in anticipation of proposed MARCA rules for 2018 that address a number of member concerns about complying with regulations for the 2017 performance year. Among those recommendations:

1. Remove the financial risk standards from regulatory definitions of Medical Home Model.

2. Remove arbitrary size restrictions limiting AAPM participation on Medical Home Models.

3. Eliminate all documentation guidelines for evaluation and management codes for primary care physicians in both the MIPS and AAPM pathways.

4. Jettison the complicated and entirely uncalled-for MIPS APM category.

5. Eliminate administrative claims population health measures.

6. Use consistent terms from proposed to final rulemaking to avoid confusion in the physician community.

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