MGMA 2017: CMS’ Kate Goodrich says expect final MACRA rule soon; reacts to MedPAC plan to toss MIPS

CMS will publish a final rule on MACRA by Nov. 1.
Kate Goodrich
Kate Goodrich, M.D.

ANAHEIM, California—Physician practices will get a look at the final rule outlining the second year of the Medicare payment system within the next few weeks.

The Centers for Medicare & Medicaid Services (CMS) must publish the final rule on the Medicare Access and CHIP Reauthorization Act (MACRA), which will include the quality measures for 2018, by Nov. 1, Kate Goodrich, M.D., the agency’s chief medical officer, said yesterday.

Goodrich addressed an audience at the Medical Group Management Association annual conference in Anaheim, California, to provide an update on the new payment system, which took effect this year.

Following the session, Goodrich told FiercePracticeManagement she could not get more specific on the date for the release of the final rule or what exactly will be in the final regulations that will govern the second year of MACRA.

“I don’t think you are going to see a significant shift in measures from year one to year two,” she said during the presentation, when an audience member asked her when physician practices would know what quality measures would be in place in 2018.

CMS released a 1,058-page proposed rule in June that would ease some of the requirements of the MACRA payment system, increasing flexibility and reducing the burden on clinicians. Stakeholders had until August to comment on the proposal, but until the rule is released in final form it’s unknown what changes the agency will make in response.

Anders Gilberg, the MGMA’s senior vice president of government affairs, said he expects both the MACRA final rule and physician fee schedule to be finalized right around the Nov. 1 date. Both are currently with the Office of Management and Budget, which reviews agency programs and policies before their release, he told FiercePracticeManagement.

The death of MIPS may be greatly exaggerated

One audience member also asked Goodrich about last week’s recommendation from the Medicare Payment Advisory Commission (MedPAC) to “sunset” the Merit-based Incentive Payment System (MIPS), one of the two payment tracks under MACRA.

“I read the report on the plane. I think it’s very interesting,” Goodrich said. But much of the proposal would require statutory changes that would need to be approved by Congress.

“Obviously sunsetting MIPS isn’t an option unless Congress sunsets it,” she said.

But she also said it may be possible to adopt some of the elements in the proposal in future years without a change in the law.

During a meeting last week, almost all of the members of MedPAC said the complex MIPS program should be replaced after the commission’s staff put forth a proposal for an alternative payment system. MedPAC members and staff said MIPS is too much of a burden for physicians and doesn’t accomplish the goal of rewarding high-value physicians and improving care.

The MedPAC proposal would eliminate MIPS and its reporting requirements and create a new voluntary value program. It would eliminate clinician reporting of quality measures and make use of measures calculated from claims. Goodrich said that idea would probably be met with a range of reactions from provider groups.

“There are aspects of it that I think are very intriguing, that are worth having more discussions around. We will see what happens,” she said, but admitted she was being asked about the news. “Everyone is very interested.”

Gilberg said he was not surprised by the MedPAC recommendation. “It recognizes what our members have said for a long time: This program is largely a reporting program,” he said.

Anders Gilberg
Anders Gilberg

MIPS needs to evolve to provide physician practices with feedback they can use to take action to improve the quality of patient care so physicians can see a return on investment for what they are spending to participate in the payment system, he said.

Still time to participate in MIPS, avoid penalty

Under the “pick-your-pace” option during the first year of MIPS, physician practices can still participate in the program, Goodrich said.

Doctors who wanted to fully participate in MIPS and earn a small positive Medicare payment adjustment just faced an Oct. 2 deadline to begin collecting performance data for a 90-day period.

CMS’ new service center for its so-called Quality Payment Program under MACRA saw a spike in calls as the Oct. 2 deadline approached for those who want to submit 90 days of performance data, she said. However, in the first year of MIPS, practices can also submit a single measure for a single patient as they test out the program, Goodrich said, adding she wants to get the word out that the deadline was only around the 90-day reporting period.

The game isn’t over for those who want to report a single measure. “You won’t get a [payment] bonus, but you won’t get a penalty,” she said.