Changes to proposed MACRA rule offer little relief for small practices

Adjustments to the proposed rule for value-based payment models encompassed by the Medicare Access and CHIP Reauthorization Act (MACRA) have not done enough to even the playing field for smaller practices, according to an article in Medscape.

Concern over elements of the Merit-based Incentive Payment System (MIPS) drove the Centers for Medicare & Medicaid Services (CMS) to streamline and simplify the proposed rule.. Despite these tweaks, the estimated effects of the proposed MIPS regulations result in penalties for 87 percent of solo practitioners, while rewarding 81.3 percent of practices with 100 or more physicians, according to CMS data.

Those numbers are "inconsistent with the congressional intent, and inconsistent with what CMS has been saying," Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association, told Medscape. "Any program like this should give physicians the opportunity to succeed regardless of practice size," he added.

As industry groups pore over the 962-page proposed rule, the practical outline becomes clearer. A blog post from The Advisory Board Company's Daily Briefing lays out some high-level takeaways, including these:

  • MIPS reporting now requires only six measures, significantly fewer than the previous system, but small groups will be more accountable for their performance under the Physician Quality Reporting System than they were previously.
  • Rules surrounding the alternative payment model track are complex, stringent and evolving, which means more clinicians will start on the MIPS track, per CMS.
  • The comment period and the tremendous stakes in play mean more changes could easily be ahead before MACRA's final implementation, especially given the mixed reviews it has received to date.

To learn more:
- read the Medscape article
- here's the blog post
- here's the proposed rule (.pdf)