Healthcare organizations were mostly upbeat about proposed payment rule changes that the Centers for Medicare & Medicaid Services released yesterday.
The groups agree that CMS listened to doctors' concerns in drafting proposed changes to the Medicare Access and CHIP Reauthorization Act (MACRA) for 2018—the second year of the program—designed to make it easier for small, independent and rural practices to participate. It also increases flexibility and reduces the burden on doctors and other clinicians by simplifying reporting requirements.
Clinicians participate in MACRA under two tracks: Advanced Alternative Payment Models or the Merit-based Incentive Payment System (MIPS).
The initial reaction to the proposed rule from at least four healthcare groups was positive and indicated CMS had heard the pain points from the country's physicians.
Anders Gilberg, senior vice president for government affairs at the Medical Group Management Association, called the changes “a win” for the organization in a Twitter post. He said the rule delays implementation of rigid 2015 electronic health record requirements, keeps the cost component for MIPS at zero percent and expands the low volume threshold that exempts practices with a small number of Medicare patients from the program.
American Medical Association President David O. Barbe, M.D., said CMS heard the concerns of practicing physicians in providing more flexibility and proposing a number of policies to help them avoid penalties under the program.
“Not all physicians and their practices were ready to make the leap, and many faced daunting challenges. This flexible approach will give physicians more options to participate in MACRA and takes into consideration the diversity of medical practices throughout the country,” Barbe said in an announcement.
The American Hospital Association also landed in the pro column.
"Today's proposed rule continues the incremental, flexible implementation approach called for by hospitals, health systems and the more than 500,000 employed and contracted physicians with whom they partner to deliver care," Executive Vice President Tom Nickels said in a statement.
Premier healthcare alliance, one of 10 provider associations that earlier this month called for the government to modify regulations to count Medicare Advantage to qualify under MACRA as early as 2019, said it was encouraged CMS was seeking comment on that proposal and pleased CMS was allowing individual clinicians to join virtual groups as a new channel to participate in MIPS.
But not everyone was happy with the plan to slow MACRA implementation.
The AMGA said it recognizes the burden MACRA places on small practices and appreciates the options for them to participate, but is concerned about the delay in the transition to value-based care and the investment its members have made to prepare for the change.
“If CMS wants to transition to value-based payment for care, the program needs to be fully implemented,” said Chester A. Speed, vice president, public policy, in a statement. “We recommend that CMS revise its proposal to fully incentivize high performers in the Medicare program.”
Groups have until August 18 to comment on the proposed rule before CMS finalizes it.