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Healthcare Associations to Congress: Extend MACRA Flexibilities by Three More Years

October 16, 2017
by Rajiv Leventhal
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Several prominent healthcare associations and medical societies have written a letter to leading members of the Committee on Energy and Commerce, proposing to continue current MACRA flexibilities for an additional three years.

The first program year of MACRA (the Medicare CHIP and Reauthorization Act of 2015) began in January 2017, with a Quality Payment Program inclusive of two payment paths that eligible Medicare-participating physicians could partake in—the MIPS (the Merit-based Incentive Payment System) track and the advanced alternative payment model (APM) track. The first year of the program was dubbed a “pick your pace” year in which eligible Medicare clinicians just had to report the minimum amount of data to CMS (the Centers for Medicare & Medicaid Services) to avoid a negative payment adjustment. Then, as Healthcare Informatics reported in June, CMS, while scaling back some of the flexibilities it was offering in year one, also proposed some ways that providers could ease into the program in 2018, as well.

But in this letter to Committee Chairman Greg Walden (R-Ore.) and Ranking Member Frank Pallone (D-N.J.), the multitude of healthcare associations wrote, “We are proposing to continue the existing flexibility in the MACRA statute that CMS is currently using for an additional three years so that the agency may move forward as the necessary program elements are put in place.”

The letter, led by the American Medical Association (AMA), pointed out that MIPS’ Resource Use (Cost) category—one of four categories of eligible clinician performance, contributing to an annual MIPS final score of up to 100 points—was originally slated to not be weighted for 2017 MIPS scores, but can be weighted for 2018 and beyond. But then in the proposed Quality Payment Program rule for 2018, CMS suggested to keep it at zero percent in 2018, but to go up to 30 percent in future program years (2019 and beyond). For this category, CMS has noted that it will compare resources used to treat similar care episodes and clinical condition groups across practices, which can be risk-adjusted to reflect external factors.

The associations wrote in the letter, “This action in no way is meant to diminish the commitment of CMS or the physician community to incorporating resource use as an integral component of performance measurement. It is instead an acknowledgement that work remains to be done to ensure that these new measures are developed and integrated in a way that accurately reflects the complexities of cost measurement and does not inadvertently discourage clinicians from caring for high-risk and medically complex patients, as was the case under the value-based modifier.”

Another flexibility the letter referred to is allowing for the selection of a performance threshold during the first two years other than the “mean or median” standard. The organizations wrote, “Gradually increasing the performance threshold gives physicians the opportunity to implement necessary practice changes as they gain experience. It also ensures that the performance threshold is not set too high, which could discourage participation or negatively impact practices with fewer resources.”

However, the letter pointed out that these provisions, and others, expire after year two of the program. As such, they wrote, “We believe that CMS will be more successful in achieving Congress’s intent to focus payment systems on  improving quality and value if some elements of the current flexibility provided for in statute are extended for an additional three years.  To be clear, we are not proposing to prevent CMS from implementing resource use measurement or a higher performance threshold if they believe that moving forward with these elements is appropriate.” Rather, they are proposing to extend the program’s flexibility years by another three.

A final rule for the 2018 program year is expected to be published by CMS in the coming weeks.

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