More than 800,000 docs get pass on MACRA com­pli­ance, for now

Modern Healthcare - - NEWS - By Vir­gil Dick­son

The agency gave a pass to providers who have im­ple­mented a MACRA-com­pli­ant Ad­vanced Al­ter­na­tive Pay­ment Model, which is the other value-based re­im­burse­ment track doc­tors com­ply­ing with the law can choose.

Physi­cians who have been anx­iously wait­ing to find out if they were go­ing to have to meet new re­port­ing re­quire­ments are breath­ing a sigh of re­lief.

The CMS last week no­ti­fied 806,879 clin­i­cians that they will not have to com­ply with Merit-based In­cen­tive Pay­ment Sys­tem re­port­ing re­quire­ments in 2017, po­ten­tially sav­ing them mil­lions col­lec­tively in com­pli­ance costs.

The ma­jor­ity of physi­cian prac­tices were ex­pected to use MIPS to com­ply with the Medi­care Ac­cess and CHIP Reau­tho­riza­tion Act, as op­posed to al­ter­na­tive pay mod­els. Un­der MIPS, pay­ments would be based on a com­pi­la­tion of qual­ity mea­sures and use of elec­tronic health records.

Last Oc­to­ber, the agency cal­cu­lated that as many as 780,000 clin­i­cians would not have to com­ply with MIPS re­quire­ments. Up to 642,000 physi­cians were slated to sub­mit MIPS data, but that num­ber has now dropped to 418,849.

The agency used an up­dated formula to es­ti­mate providers’ Medi­care rev­enue, which changed the fi­nal par­tic­i­pa­tion num­bers, a CMS spokes­woman said.

The CMS es­ti­mated MACRA com­pli­ance will cost the health­care in­dus­try up to $1.3 bil­lion.

The ex­empted physi­cians in­clude those with less than $30,000 in Medi­care charges and fewer than 100 unique Medi­care pa­tients per year. Clin­i­cians new to Medi­care this year are also ex­empt this year.

The agency also gave a pass to providers who have im­ple­mented a MACRA-com­pli­ant Ad­vanced Al­ter­na­tive Pay­ment Mod- el, which is the other value-based re­im­burse­ment track doc­tors com­ply­ing with the law can choose. Un­der MIPS, physi­cian pay will be based on suc­cess in four per­for­mance cat­e­gories: qual­ity, re­source use, clin­i­cal prac­tice im­prove­ment and “ad­vanc­ing care in­for­ma­tion” through use of health in­for­ma­tion tech­nol­ogy.

The ad­vanc­ing care cri­te­ria is based on the gov­ern­ment’s mean­ing­ful-use pro­gram, which is used to de­cide whether doc­tors should be re­warded for us­ing EHRs.

Medi­care re­im­burse­ment for providers in 2019 will be based on how well doc­tors per­form on these met­rics this year. Un­der MIPS, physi­cians can earn a bonus or penalty of 4% of their re­im­burse­ment in 2019.

The CMS missed a De­cem­ber time­line to no­tify physi­cians of MIPS re­port­ing re­quire­ments. That de­lay could have af­fected some doc­tors’ bot­tom lines, as they may have spent money to up­grade EHRs and ad­min­is­tra­tive pro­ce­dures to im­ple­ment MIPS only to be told they didn’t need to, ac­cord­ing to An­ders Gil­berg, se­nior vice pres­i­dent of gov­ern­ment af­fairs for the Med­i­cal Group Man­age­ment As­so­ci­a­tion.

“With so many ex­cep­tions, physi­cians need to know their sta­tus prior to the per­for­mance year,” Gil­berg said. “CMS no­ti­fy­ing physi­cians and group prac­tices in May of the per­for­mance year cre­ates con­fu­sion and need­less frus­tra­tion.”

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