Final MACRA rule expands exemptions, flexibility

On October 14th, 2016, posted in: Industry News by

Nearly a third of physicians could be exempt from Medicare’s new merit-based incentive payment system under a final rule the CMS issued Friday for implementing the Medicare Access and CHIP Reauthorization Act.

The CMS also signaled it would broaden the opportunities for physicians to participate in alternative models that make them eligible for bigger rate increases and bonuses.

In April, the CMS released the proposed rule on MACRA, which replaced the old and flawed sustainable growth-rate formula for physician pay with a new method meant to shift physicians away from the fee-for-service model and onto a value-based payment system. To avoid penalties under MACRA, physicians will participate in one of two reimbursement tracks: a merit-based incentive payment system or advanced alternative payment models.

In the merit-based incentive payment system, known as MIPS, physician pay will be based on success in four performance categories: quality, resource use, clinical practice improvement and “advancing care information,” which is based on the meaningful-use program the government has used to decide whether doctors should be rewarded for using electronic health records.

The agency heeded the concerns of small practices and Congress about the framework’s impact on small practices and broadened its exclusion for providers who treat a low volume of Medicare patients from MIPS.

To help ease the impact on small providers, the CMS will exempt physician practices with less than $30,000 in Medicare charges or fewer than 100 unique Medicare patients per year. The draft rule set the threshold at $10,000 a year.

An analysis by the American Medical Association found that about 16% of all MIPS-eligible clinicians would be exempt under the proposed version of the rule. The threshold in the final rule would exclude 30% of physicians, according to the AMA analysis.

The CMS noted that more than 93% of Medicare Part B charges would still be subject to the incentive framework, which was devised to nudge physicians toward value-based care.

Acting CMS Administrator Andy Slavitt said in conference call with reporters that the thousands of comments received on the proposed rule could be summarized as: “Make the transition to MACRA as simple and as flexible as possible.”

The CMS said it would provide $100 million in technical assistance to clinicians participating in MIPS who are in small practices, rural areas and in areas with a shortage of health professionals.

The MACRA got rid of the “meaningful use” rule that the administration previously used to decide if providers should be rewarded for using electronic health records, but doctors will still be accountable for using health information technology under the “advancing care information” performance category in the rule that counts 25% towards a physician’s overall performance score, as was proposed initially.

Heeding calls for more flexibility, the CMS in the final rule said it will move away from the “all or nothing” approach previously used in EHR incentive programs. The rule reduces the total number of required measures under the category to five from 11 in the proposed rule. All other measures will be optional for reporting.

Required measures include security risk analysis, e-prescribing, providing patient access, sending summary of care and requesting and accepting summary of care. The required measures must be fulfilled for a minimum of 90 days to receive credit.

The CMS said that while public comments called for the category to allow for reporting on “use cases,” such as the use of EHRs to manage referrals and consultations, it did not include such policies in the final rule. However, in 2017 the CMS will add bonus points for improvement activities that use EHRs and for reporting to a public health or clinical data registry.

The CMS also said that eligible clinicians participating in MIPS must show that they are engaged in activities that support health care providers on the performance of certified electronic health record technology, such as cooperating with the ONC’s review of the technology, and that they are not blocking data sharing.

The final regulations also answer requests for lower minimum reporting thresholds. The agency originally wanted providers to report quality measures on 90% of their patients from all payers, and 80% of Medicare patients. Small providers argued they would have a harder time obtaining the information technology and data needed to meet that requirement. The final rule drops the Medicare threshold to 50%.

Between 592,000 and 642,000 clinicians, according to the rule, are expected to submit data for MIPS during the first performance year, which begins Jan. 1.

The CMS also said it was expanding opportunities to participate in programs that qualify as “advanced alternative payment models” under the law. Practices with a significant portion of their revenue under such a model are exempt from MIPS and qualify for larger rate increases and bonuses.

The agency now estimates that more than 125,000 clinicians will participate in advanced APMs for the 2018 performance year.

Slavitt said the CMS plans to develop more APMs through the CMS Innovation Center. “Ultimately, we believe that we’re not looking to transform the Medicare program in 2017, we’re looking to make a long-term program successful,” he said.

Article source: http://www.modernhealthcare.com/article/20161014/NEWS/161019942

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