CMS eyes larger MACRA carve-out for small practices

The CMS’ proposal to give even more physicians a reprieve from new quality reporting and payment policies garnered mixed reviews from provider groups.

“Not all physicians and their practices were ready to make the leap, and many faced daunting challenges,” American Medical Association President Dr. David Barbe said in a statement on the CMS’ proposed rule last week to ease requirements under the Medicare Access and CHIP Reauthorization Act. “This flexible approach will give physicians more options to participate in MACRA and takes into consideration the diversity of medical practices throughout the country.”

The agency proposed that physician practices with less than $90,000 in Medicare revenue or fewer than 200 unique Medicare patients per year be exempt from MACRA. The original threshold was $30,000 or fewer than 100 Medicare patients. If adopted, the proposal would mean that about 834,000 physicians would not have to comply.

Between alternative payment models and small practice exemptions, only 37% of 1.5 million Medicare clinicians now billing under Medicare will be complying with MACRA, according to the CMS. But since large practices still account for the bulk of care for beneficiaries, 65% of Medicare payments would still be reported under methods that adhere to MACRA even if this draft rule were finalized.

Nonetheless, Chet Speed, vice president of public policy at the American Medical Group Association, urged the agency to continue to embrace new payment models. “If the CMS wants to transition to value-based payment for care, the program needs to be fully implemented,” he said. “We recommend that the CMS revise its proposal to fully incentivize high performers in the Medicare program.”

CMS Administrator Seema Verma said that the proposal was crafted in response to concerns from small practices that they won’t be able to survive under MACRA’s regulatory framework. “We’ve heard the concerns that too many quality programs, technology requirements and measures get between the doctor and the patient,” Verma said in a statement about the rule. “That’s why we’re taking a hard look at reducing burdens.”

The CMS estimates that the number of clinicians participating in an alternative payment model under MACRA will double next year, totaling anywhere from 180,000 to 245,000 clinicians.

Comments on the proposed rule are due Aug. 30.