CMS offers flexibility on MACRA, gives doctors ways to avoid payment adjustments

Health and Human Services building

The Centers for Medicare and Medicaid Services has listened to the concerns of physicians, lawmakers and others, and is offering flexibility on implementing the Medicare Access and CHIP Reauthorization Act.

With the Quality Payment Program under MACRA set to begin on January 1, 2017, CMS is offering clinicians four options to comply and avoid a negative payment adjustment in 2019, CMS Acting Administrator Andy Slavitt said in his Thursday blog.

The first option will allows clinicians to submit some data to the Quality Payment Program, including data from after January 1, 2017, to avoid a negative payment adjustment.

[Also: CMS chief Andy Slavitt again floats possible MACRA delay]

This first option is designed to ensure the system is working and that physicians are prepared for broader participation in 2018 and 2019, Slavitt said.

The second option will allow for participation for part of the calendar year. Clinicians may choose to submit Quality Payment Program information for a reduced number of days.

The first performance period could begin later than January 1, 2017 and the practice could still qualify for a small positive payment adjustment, Slavitt said.

For example, a practice could submit information for part of the calendar year on how the practice uses technology, and what improvement activities it is undertaking, he said. Clinicians may choose from a list of quality measures and improvement activities available under the Quality Payment Program.

The third option requires participation for the full calendar year, for practices that are ready to go on January 1, 2017. Physician practices that submit information for the entire year on quality measures could qualify for a modest positive payment adjustment.

"We've seen physician practices of all sizes successfully submit a full year's quality data, and expect many will be ready to do so," Slavitt said in the blog.

The fourth option is for those participating in an Advanced Alternative Payment Model in 2017. Instead of reporting quality data and other information, the law allows participation in an Advanced APM such as Medicare Shared Savings Track 2 or 3 in 2017.

Those that receive enough of their Medicare payments or see enough of their Medicare patients through an Advanced APM in 2017 would qualify for a 5 percent incentive payment in 2019, Slavitt said.

The four options will be described more fully in the final rule to be issued by November 1, he said.

Slavitt said in his blog he received feedback on CMS's April proposal for implementing the Quality Payment Program on how excessive reporting can distract from patient care; how to encourage new programs such as medical homes; and the unique issues facing small and rural non-hospital-based physicians.

[Also: Lawmakers ask HHS to be flexible with MACRA, stop short of backing delay]

In April, CMS proposed two models physicians could choose for the Quality Payment Program in the implementation of MACRA: a Merit-based Incentive Payment System (MIPS); or the riskier Advanced APM.

The majority of physicians are expected to pursue MIPS, which is based on a compilation of quality measures and the use of electronic health records.

Physician groups have asked for more flexibility and time to comply. Two months ago, Slavitt said the agency was considering a delay.

This week, leaders from the House Ways and Means Committee and the House Energy and Commerce Committee sent a letter to Health and Human Services Secretary Sylvia Burwell urging flexibility with the rollout of the payment programs under MACRA.

Advocates applaud move

The American Medical Association, which is already aired concerns over how the law burdens small practices in particular, backed the move by CMS to make MACRA implementation more flexible for doctors, saying it gives providers a fair shot at succeeding in the first year.

"By adopting this thoughtful and flexible approach, the administration is encouraging a successful transition to the new law by offering physicians options for participating in MACRA. This approach better reflects the diversity of medical practices throughout the country," AMA President Andrew Gurman said in a statement.

"This is the flexibility that physicians were seeking all along."

Chairman of the House Energy and Commerce Subcommittee on Commerce, Manufacturing, and Trade Rep. Michael Burgess said CMS showed that it took concerns seriously.

"Today's announcement from CMS regarding the agency's dedication to flexibility in the implementation of MACRA is proof of the benefits of keeping Congress involved in policy implementation," he said in a statement. "Just as this policy was carefully crafted with the input of everyone affected by the payment policies, the implementation process should be conducted in the same way."

Twitter: @SusanJMorse