CMS releases updated proposed rule for MACRA, eases burden on small and rural practices

The Centers for Medicare & Medicaid Services has unveiled a proposed rule that updates the Medicare physician payment system implemented under MACRA with changes to make it easier for small independent and rural practices to participate.

The 1,058-page proposed rule (PDF), published in the Federal Register, aims to increase flexibility and reduce the burden on doctors and other clinicians by simplifying reporting requirements and offering support for them in 2018, the second year of the Medicare Access and CHIP Reauthorization Act (MACRA).

CMS said in an announcement that its goal in formulating the proposed rule to what it calls its Quality Payment Program is to simplify the program, especially for small, independent and rural practices—which lawmakers and healthcare leaders have feared would have the greatest difficulty complying with the MACRA requirements.

“We’ve heard the concerns that too many quality programs, technology requirements, and measures get between the doctor and the patient,” CMS Administrator Seema Verma said in the announcement. “That’s why we’re taking a hard look at reducing burdens. By proposing this rule, we aim to improve Medicare by helping doctors and clinicians concentrate on caring for their patients rather than filling out paperwork.”

RELATED: Doc groups upbeat about proposed 2018 MACRA changes

Updated annually as part of MACRA, this is the first opportunity for the Trump administration to put its stamp on the program, as both Trump appointees Verma and HHS Secretary Tom Price had input into the proposed rule.

RELATED: Doctors look to HHS Secretary Tom Price to provide MACRA relief; proposed Medicare rule in the works

A look at what's in the proposed rule

CMS released a 26-page fact sheet (PDF) to summarize the lengthy proposal. The agency said clinicians can choose how they want to participate in the payment program based on their practice size, specialty, location or patient population.

The proposed rule would amend some existing requirements and also contains new policies for doctors and clinicians that would encourage participation in either Advanced Alternative Payment Models (APMs) or the Merit-based Incentive Payment System (MIPS). CMS said it took feedback from clinicians to shape the second year of the program.

Here are some of the major changes proposed under the rule, which is open for comment until Aug. 18:

  • Increases the MIPS' low-volume threshold, thereby exempting more than 585,000 eligible clinicians from the program and its reporting requirements. CMS will increase the threshold to exclude clinicians or groups from those with $30,000 to $90,000 in Part B charges or fewer than 100 to 200 Part B beneficiaries.
  • Offers a virtual groups participation option under MIPS. Virtual groups would be composed of solo practitioners and groups of 10 or fewer eligible clinicians, eligible to participate in MIPS, who come together “virtually” with at least one other such solo practitioner or group to participate in MIPS for a performance period of a year.
  • Continues to allow the use of 2014 Edition CEHRT (Certified Electronic Health Record Technology), while encouraging the use of 2015 edition CEHRT.
  • Adds flexibilities for clinicians in small practices, including a new hardship exception for clinicians in small practices under the Advancing Care Information performance category, adds bonus points to their final score and continues to award small practices 3 points for measures in the quality performance category that don’t meet data completeness requirements.
  • Allows flexibilities for clinicians who are considered hospital-based or have limited face-to-face encounters with patients.
  • Puts in place new policies related to clinicians' ability to earn incentives for participation in advanced APMs.