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Physicians in Congress Call for Significant MACRA Rule Changes

The Medicare Access and CHIP Reauthorization Act (MACRA) could transform healthcare, but if the Centers for Medicare and Medicaid Services (CMS) doesn’t follow congressional intent with its regulations, compliance could become even more complicated than the current system. This is according to 18 congressional members in a recent letter to CMS Acting Administrator Andrew Slavitt and Office of Management and Budget Director Shaun Donovan.

“We urge you to carefully address a number of multi-layered, high-level concerns that likely require multi-faceted solutions,” the representatives, who are also physicians, nurses and other members of the healthcare community, said. “Thus, we encourage the agency to take note of the technical issues being presented in the comment letters of the various providers, specialty physicians and medical industry stakeholders.”

Although experts agree that the letter likely will not impact CMS’s path for MACRA implementation, it pointed to specific actions the agency can take to address concerns expressed by healthcare providers across the country. The group raised four main concerns in the letter and offered suggestions for changes to include in the final rule.

  1. MIPS is too complex.
    • MIPS should engage clinicians with a reporting system that is not burdensome.
    • The scoring system should be simple and transparent with attainable thresholds.
    • There should be a short quality/payment feedback loop to allow physicians to learn and make necessary changes to avoid future penalties.
    • Feedback reports should be more detailed so that clinicians understand their performance ratings, more quickly rectify data inaccuracies, and submit timely appeals before payment reductions are applied.
    • There should be an appeals process that is transparent and not burdensome throughout the MIPS process.
  1. Performance period start and length are unrealistic.
    • The Jan. 1 start date is too aggressive because physicians need more time to prepare once CMS releases the final MACRA rule and the final list of qualified Advance Alternative Payment Methods (APM).
    • CMS should adopt a 90-day reporting period, instead of one year, for the MIPS Advancing Care Information (ACI) category to allow small practices a better chance transition to MIPS and upgrade their electronic health record (EHR) technology.
  1. MIPS will drive consolidation in small and rural practices.
    • To help reduce administrative burden for smaller practices, CMS should lower its patient minimum reporting thresholds to 50 percent of Medicare patients. The proposed rule requires reporting quality measures on 90 percent of patients for all payers or 80 percent on Medicare patients if reporting by claims.
    • Although CMS has put off implementing virtual groups as outlined in the legislation until the 2018 performance period, the agency should form these groups as soon as possible so physicians can take advantage of them.
    • CMS should increase the threshold for exclusion from MIPS based on Medicare patient volume from $10,000 AND fewer than 100 such patients in a year to $30,000 in Medicare allowables OR fewer than 100 patients per year.
  1. Proposed resource measures may not be accurate or relevant.
    • CMS should make the Resource Use category optional for the first reporting year while the agency refines the measures and related methodologies.

CMS has not responded directly to the letter from the congressional representatives. Further, the agency has stated that it will release the final MACRA rule by Nov. 1. You can review a copy of the letter on Rep. Tom Price’s (D-GA) website. Rep. Price is one of the key signers of the letter to CMS.

Once again, experts agree that MACRA is happening, and the recent letter from congressional members isn’t going to change that.

For more information on MACRA compliance, Coding Leader offers several options, including the online training session, Master MACRA to Keep Getting Paid, and the upcoming MACRA 2017 Special Report: Master MIPS Scoring Metrics to Avoid Medicare Payment Cuts.

Comments on this post (1)

  • Oct 13, 2016

    A delay would be nice, but I don’t think it’s going to happen.

    — Mark W.

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