Physicians wait with trepidation for final MACRA rule


The final rule that will result in a major overhaul of how physicians are paid under Medicare is expected next month and there’s still a lot of trepidation over the changes that will take place under the new payment system.

Physicians and the leaders of the organizations that represent them remain worried the new rule that will implement the Medicare Access and Chip Reauthorization Act (MACRA) is too narrow and too complex to achieve its goal of providing a value-based payment system, according to MedPage Today.

Worries persist that the final rule, which will be released soon by the Centers for Medicare & Medicaid Services (CMS), will hurt small and rural medical practices and pit primary care doctors against specialists, according to the report. Under MACRA, top-performing doctors will receive bonuses and underperformers will see negative incentives based on a variety of measures, including quality of care.

CMS released a proposed rule last April and physicians were encouraged by acting administrator Andy Slavitt’s recent announcement of a ‘pick your pace’ format that will provide flexible options to satisfy reporting requirements in 2017.

But the worries continue. The American Osteopathic Association is concerned that under the payment channel providing for advanced alternative payment models (APMs), options are too limited, Laura Wooster, MPH, told MedPage Today. The group has lobbied to include patient centered medical homes in that APM pathway.

Another big concern is that small practices be able to compete under the other payment pathway--the Merit-Based Incentive Payment System (MIPS). "They don't have the resources or a broad risk pool even, they feel like they'll be at a competitive disadvantage," Wooster said.

Republican lawmakers are also worried about how MIPS--the reimbursement system most physicians will operate under--will play out and warned CMS in an October 6 letter that if changes aren’t made in that final rule, small practices may not survive.

The GOP Doctors Caucus--a group of 18 Republican members of Congress that includes 8 physicians and others with a heatlhcare background--sent the letter to Slavitt and the Office of Management and Budget voicing their worries that the proposed rule is too burdensome and could lead to more consolidation and higher healthcare costs.

As they wait for the final rule, physician groups are working to prepare their members for the pending changes. With the clock ticking on the proposed January 1, 2017 start date, the American Hospital Association has released a MACRA tracker to help hospitals prepare.