CMS eyes larger MACRA carve-out for small prac­tices

Modern Healthcare - - NEWS - By Vir­gil Dick­son

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.

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