Physician groups want shorter MACRA reporting periods, rewards for improvement

Doctors groups made their voices heard on a proposed rule to revise MACRA.

With Monday’s deadline to submit comments on a proposed rule that would ease some of the requirements of the MACRA payment system, medical groups made their voices heard.

For the most part, physician groups appreciated many of the proposed changes put forward in June by the Centers for Medicare & Medicaid Services. But that doesn't mean they're totally happy. 

CMS said it proposed changes for 2018 to make it easier for small, independent and rural practices to participate. Indeed, the changes reflect doctors’ concerns about the payment system that was put in place under the Medicare Access and CHIP Reauthorization Act (MACRA).

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Many of the proposals will afford physician group practices “with stability and flexibility” during the second year of the program, the Medical Management Group Association said, with steps to reduce burdens under the Merit-Based Incentive Payment System (MIPS) and support physician practices as they transition to alternative payment models (APMs).

But in a 44-page letter (PDF) to CMS, the group offered multiple recommendations, including shortening minimum reporting periods to 90 days and simplifying MIPS by awarding cross-category credit.

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The American Medical Association also urged CMS to make changes in the final rule to make the program even simpler and more flexible. The group submitted comprehensive comments (PDF) in its own 69-page letter. 

“When physicians are asked to move to a new program, we expect some bumps along the way. CMS has been a good partner in smoothing out the bumps but the program still needs to be more understandable and less burdensome,” AMA President David O. Barbe, M. D. said in an announcement.

The AMA recommended CMS maintain a slow pace to developing its methodology for measuring and rewarding performance improvement.

The American Hospital Association also weighed in with a 17-page letter (PDF), applauding CMS for responding to its request to develop a facility-based measurement option for MIPS and supporting changes that relieve regulatory burden, including the gradual, flexible increase in reporting requirements.

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But not everyone was happy about CMS’ effort to put the brakes on MACRA requirements. In a statement, The AGMA said the proposed rule needs significant changes to support a value-based Medicare program. In a letter (PDF) to CMS, the group said it opposes proposals to increase MIPS exclusions and exclude Medicare Advantage from the advanced APM threshold test.

“In a well-intentioned effort to make the transition to value-based care as smooth as possible, CMS is delaying this transition,” said Ryan O’Connor, AMGA’s interim president and CEO. “Excluding two-thirds of providers from the MIPS program does not meet Congress’ goal to transform Medicare into a value-based purchaser of care.”