MACRA final rule perpetuates disconnect between performance, feedback, MGMA argues

Feedback from the healthcare industry prompted the Centers for Medicare and Medicaid Services to release a final version of MACRA's Payment Quality Program that adds flexibility, like 90-day reporting, to overhaul how physicians are paid under Medicare. But the Medical Group Management Association has said the final rule still puts pressure on clinicians.

In a statement, the group said, "It's disappointing that flexibility provided for quality reporting in 2017 largely disappears in 2018 and beyond. The Centers for Medicare and Medicaid Services missed an opportunity to close the two-year gap between the measurement and payment periods, which would facilitate improved patient care by providing actionable feedback to physicians and more timely incentives. The sheer magnitude of a 2,400-page regulation and its impact on physician practices can't be ignored."

[Also: UPDATED: CMS releases MACRA final rule, makes 2017 'transition year,' adds 90-day reporting option]

Anders Gilberg, MGMA's senior vice president for government affairs, said the requirements on smaller practices aren't onerous. It's achievable, he said, for those practices to avoid a penalty. Gilberg's chief concern isn't that there needs to be a transition year, but that there were some missed opportunities when it came to simplifying the provisions of the rules to make them more sustainable long-term.

"Most importantly, we view a new value-based payment system as one in which there is a significant feedback loop from, in this case, Medicare, to the private sector," said Gilberg. "How these systems work with payers is that there is a constant data flow between the payers and the providers who are engaged in value-based payment models, whether it be MIPS or APMs, where there is timely, actionable feedback provided to physician practices to provide interventions that improve outcomes and cost.

[Also: MACRA reactions light up social media as organizations post early responses to 2,400-page rule]

"But what they did was they perpetuated a two-year gap in (the physician quality reporting system)," he said. "The two-year gap means that for what you do in 2017, you'll get feedback in the middle of 2018, and some kind of upward or downward incentive in 2019. But if you see a patient in January of '17, you're not going to get feedback until mid-2018, so there's just a fundamental disconnect when you have the performance year so removed from the incentive year -- the payment year."

Gilberg maintained that the provisions of MACRA aren't necessarily locked in; as with anything in Washington, he views rules of this sort as an evolution, with room for change -- as has been the case with meaningful use.

At a minimum, Gilberg said 2017 should provide an opportunity for all practices to submit some data and avoid a penalty, and at relatively low risk. Particularly with Congressional oversight and a new administration next year, he expects the MACRA picture to be continually evolving over the next decade.

"We would encourage every practice to engage in 2017," he said.

Twitter: @JELagasse