Cms Said, ‘ Pick Your Speed ‘ In 2017, Macra Payment Procedures (Updated)

8 Sep

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In the face of much criticism over the proposed timeline for implementing Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) rules, federal officials have decided to offer flexibility, at least for 2017.

The Centers for Medicare and Medicaid Services said late Thursday afternoon that it would offer four options for physicians to participate in the outcomes-focused initiative next year. Dubbed the Quality Payment Program, this MACRA provision is intended to replace the widely reviled Medicare Sustainable Growth Rate formula and merge several existing reporting programs under one umbrella.

“In recognition of the wide diversity of physician practices, we intend for the Quality Payment Program to allow physicians to pick their pace of participation for the first performance period that begins Jan. 1, 2017,” acting CMS Administrator Andy Slavitt wrote in a blog post.

The four options are:

  • Submit some data to the Quality Payment Program as a “test.” According to Slavitt, “This first option is designed to ensure that your system is working and that you are prepared for broader participation in 2018 and 2019 as you learn more.”
  • Participate for some of the year and earn a prorated payment. ” For example, if you submit information for part of the calendar year for quality measures, how your practice uses technology, and what improvement activities your practice is undertaking, you could qualify for a small positive payment adjustment,” Slavitt said.
  • Go all out and participate for all of 2017. “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.
  • Choose a Medicare Advanced Alternative Payment Model. This program, along with the Merit-based Incentive Payment System (MIPS) are new ideas from the MACRA plan that consolidate the Physician Quality Reporting System, Meaningful Use and the Medicare value-based payment modifier.

Initial responses to this decision to offer flexibility were filled with cautious optimism.

“I think it’s welcome news for the small-practice physician,” said John Squire, president and COO of Boston-based electronic health records vendor Amazing Charts. “Anything that eases the burden is good, but it’s just for 2017.”

Squire noted that Slavitt did not offer many details, and that there is no guarantee this leniency will continue into 2018 and beyond.

Dr. John Goodson, staff internist at Massachusetts General Hospital and associate professor at Harvard Medical School, said that CMS left two major issues unaddressed: attribution and risk adjustment.

In other words, what year will the reporting be attributed to, and will CMS take into account the patient mix, since high-risk patients have a lower chance at positive outcomes?

“How can you expect to do anything prospectively if you are going to be judged retrospectively?” Goodson wondered.

Still, he likes the direction CMS is heading. “I think it gives people some breathing room,” Goodson said.

Goodson also said that value-based payment is here to stay, at least when it comes to Medicare. “The real message here is that you have to have your data in order,” he said.

Slavitt said CMS would release the final rule no later than Nov. 1.

Photo: YouTube user U.S. Department of Health and Human Services