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HHS Announces $100M in Funding to Help Small Practices with MACRA

June 21, 2016
by Rajiv Leventhal
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Officials compare the initiative to the ONC-funded Regional Extension Centers which helped small practices with EHRs

The Department of Health and Human Services (HHS) has announced $20 million each year over the next five years to fund on-the-ground Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) training and education for Medicare clinicians in individual or small group practices.

In April, federal healthcare officials released the long-awaited MACRA proposed rule, which repeals the Medicare Part B Sustainable Growth Rate (SGR) reimbursement formula and replaces it with the new Merit-based Incentive Payment Program, a quality payment program within MACRA which eligible Medicare clinicians will be participating in.

Following the release of the MACRA proposed rule, federal officials were getting pressed on the rule’s potential negative impact on smaller physician practices. Indeed, a key point of the proposed legislation brought up by multiple members of Congress at a hearing in May was a table in the rule that outlined the details of MIPS. In that table, CMS itself estimated that 87 percent of eligible solo practitioners (nearly 103,000 in total) will be hit with a negative payment adjustment in 2019, the first payment year of the program.

For slightly bigger practices, the news doesn’t get a whole lot better: 70 percent of practices with two to nine physicians are estimated to get hit with negative payment adjustments, while 59 percent of practices with 10 to 24 clinicians will be docked, according to the estimated CMS data. In terms of dollars, these negative hits could be in the range of $100 million to $300 million, per the estimation.

And, according to a May 2016 Black Book survey, 67 percent of high Medicare-volume doctors said they felt they will not have the technology, capital or staffing to sustain under the conditions of MIPS. The same amount of high Medicare-volume doctors foresee the end of their independence due to the physician payment changes that will take place under MACRA, according to that survey.

To date, Centers for Medicare & Medicaid Services (CMS) Acting Administrator Andy Slavitt has responded to the skepticism regarding the ability of eligible Medicare clinicians in small practices to handle MACRA/MIPS. He has said that CMS, through a variety of initiatives, will help small practices adapt and adjust. As such, these newly-announced federal funds will aim to help provide hands-on training tailored to small practices, especially those that practice in historically under-resourced areas including rural areas, health professional shortage areas, and medically underserved areas, according to officials.

“Doctors and healthcare providers in small and rural practices are critical to our goal of building a healthcare system that works for everyone,” HHS Secretary Sylvia Mathews Burwell said in a statement accompanying the announcement. “Supporting local healthcare providers with the resources and information necessary for them to provide quality care is a top priority for this administration.”

As required by MACRA, HHS will continue to award $20 million each year over the next five years, providing $100 million in total to help small practices (15 clinicians or fewer) successfully participate in the Quality Payment Program. In order to receive funding, organizations must demonstrate their ability to strategically provide customized training to clinicians. And, most importantly, these organizations will provide education and consultation about the Quality Payment Program at no cost to the clinician or their practice, HHS officials said in a press release announcement.

The MACRA proposed rule would implement changes to physician payment through the aforementioned Quality Payment Program, a unified framework under MACRA that streamlines various quality reporting programs and includes two paths: MIPS and alternative payment models (APMs). Most Medicare clinicians will initially participate in the Quality Payment Program through MIPS, though they won’t be locked into one path or the other in subsequent years; they can switch annually.

While MIPS allows Medicare clinicians to be paid for providing high value care through success in four performance categories—Quality, Advancing Care Information (the “new” meaningful use), Clinical Practice Improvement Activities, and Cost—advanced APMs include payment models such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs). Medicare clinicians who participate to a sufficient extent in advanced APMs would be exempt from MIPS reporting requirements and qualify for financial bonuses.

According to HHS, organizations receiving the funding would support small practices by helping them think through what they need to be successful under the Quality Payment Program, such as what quality measures and/or electronic health record (EHR) may be appropriate for their practices’ needs. Organizations would also train clinicians about the new clinical practice improvement activities and how these new activities could fit into their practices’ workflow, or help practices evaluate their options for joining an APM.

“The bipartisan MACRA legislation gave us the tools to improve Medicare and make it modern and sustainable by improving the incentives for and lowering the burden on clinicians,” Patrick Conway, M.D., acting principal deputy administrator and chief medical officer for CMS, said. “Real change must start from the ground up, and today’s announcement recognizes this reality by  getting doctors the resources they need to provide better, smarter care.”

B. Vindell Washington M.D., principal deputy national coordinator, added, “Providing these tools to help physicians and other clinicians in small practices navigate new programs is key to making sure they are able to focus on what is most important: the needs of their patients.” He noted, “As with the Office of the National Coordinator (ONC) for Health IT’s funding for Regional Extension Centers (RECs), this assistance will help healthcare providers leverage health information technology to enhance their practices and the care they deliver.” A recent report from ONC found that its REC program had a significant impact on increasing meaningful use success among physicians and small providers.

Awardees will be announced by November 2016.  HHS said it encourages all qualified organizations to apply for this funding.

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