CMS Offers Flexibility for Physician Participation in MACRA

October 14, 2016 | Health Services

Pursuant to the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”), in April 2016, the U.S. Department of Health and Human Services issued a proposed rule that will require physicians who receive Medicare payments to participate in one of two payment programs: (1) the Merit-Based Incentive System (“MIPS”); or (2) the Alternative Payment Models (“AMPS”). MACRA was enacted as an effort to improve quality of care and patient outcomes by consolidating existing Medicare quality programs: the Physician Quality Reporting Program, the Value-Based Payment Modifier and the Electronic Health Records Incentive Program. It has been predicted that majority of physicians will start in MIPS because AMPS requires a certain level of financial risk and, therefore, will be limited to physicians who participate in Accountable Care Organizations, Patient Centered Medical Homes and other bundled payment models. Those physicians participating in MIPS will be required to report to the Centers for Medicare and Medicaid (“CMS”) on certain quality and cost measures. These reporting measures will be used to determine whether the physician receives a reduction or bonus to his or her Medicare payments. Under the proposed rule, the reporting obligations would begin on January 1, 2017 and first payment adjustments would be realized in 2019.

Many physicians expressed concern that the stringent reporting obligations can distract from patient care and that they will not have enough time to comply with the rule by January 1, 2017. In response to these concerns, CMS recently announced that it intends to allow physicians to “pick their pace of participation” in the first year of MACRA. Specifically, physicians will be allowed to choose various options of participation in MIPS for 2017. Depending on the option they choose, physicians may avoid reductions in Medicare payments for 2017 but in effect may also reduce the bonus for which they could qualify in 2019.

Under the first option, as long as the physician submits some data to CMS in 2017, he or she will not be subject to any reductions in payment for that year. For physicians who select this option, 2017 would be treated as a pilot program to prepare them for greater participation in 2018 and 2019.

Under the second option, physicians would be required to submit the full amount of data requested by CMS but only for a part of the calendar year. Thus, this option allows physicians to begin participation after January 1, 2017, giving them more time to comply with the requirements.

Finally, those physicians who are ready and able to fully comply with the proposed rule by January 1, 2017 may select the third option and begin complete participation on such date. Such physicians may qualify for greater bonuses at the end of 2019 due to their participation in MIPS from the outset. CMS believes that these new options will provide physicians with more flexibility in complying with MACRA. CMS is expected to provide additional guidance when it issues a final rule on MACRA by November 1, 2016.

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