MACRA News and Alerts
House passes ObamaCare repeal
Trump, flanked by House Republicans, said from the White House Rose Garden he was “confident” the Senate would also vote to repeal ObamaCare.
“Yes, premiums will be coming down. Yes, deductibles will be coming down. But very importantly, its a great plan and ultimately thats what its all about,” Trump said.
“This has brought the Republican Party together.”
The bill, known as the American Health Care Act, repeals the core elements of ObamaCare, including its subsidies to help people get insurance coverage, expansion of Medicaid, taxes and mandates for people to get coverage.
In its place, the bill provides a new tax credit aimed at helping people buy insurance, though it would provide less help than ObamaCare to low-income people.
The Congressional Budget Office found that 24 million more people will become uninsured over the next decade because of the bill. While some of that loss is because of people choosing not to get coverage when the mandate is repealed, much of it would come from Medicaid cuts and the smaller tax credit as well.
The 20 House Republicans who voted against the bill were Reps. Andy Biggs (Ariz.), Mike Coffman (Colo.), Barbara Comstock (Va.), Ryan Costello (Pa.), Charlie Dent (Pa.), Dan Donovan (N.Y.), Brian Fitzpatrick (Pa.), Jaime Herrera Beutler (Wash.), Will Hurd (Texas), Walter Jones (N.C.), David Joyce (Ohio), John Katko (N.Y.), Leonard Lance (N.J.), Frank LoBiondo (N.J.), Thomas Massie (Ky.), Patrick Meehan (Pa.), Dave Reichert (Wash.), Ileana Ros-Lehtinen (Fla.), Chris Smith (N.J.) and Mike Turner (Ohio).
Game Changer: Preparing for Success with MACRA
We came across the whitepaper from CareSync and thought it an interesting read. See what you think.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) dramatically impacts the way Medicare payments will be made as the healthcare industry continues to shift from fee-for-service to value-based care. Here, we shed light on MACRA’s key components and explore with CareSync’s founder and CEO Travis Bond how establishing compliant, fullservice care coordination today can create success with MACRA tomorrow.
It answers these questions:
- How Did We Get Here? – Improved Care Through the Sharing of Health Information
- Where Are We Now? – MACRA: A Law Paved With Good Intentions
- Where Are We Headed? – Connecting CCM, Care Coordination and MACRA
Click HERE to download and read the entire white paper.
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.
On the MIPS track, physicians can earn plus or minus 4% of reimbursement in 2019. The adjustment potential grows to 9% in 2022.
Physicians can opt out of the MIPS track if they participate in an alternative payment model, such as an accountable care organization or patient-centered medical home. Physicians that do choose this path can earn annual bonuses of 5%, and they will also be exempt from the MIPS reporting measures.
The agency addressed concerns about the impact on small practices by broadening its exclusion for providers who treat a low volume of Medicare patients from MIPS. 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 score for the category, 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. Reporting on the optional measures can earn physicians bonus points toward their overall score.
In essence, the CMS is meeting providers where they are at, allowing some of the less advanced providers to transition in while also allowing the advanced ones to do more under the law and thus, earn more of a payment adjustment, said Anne Phelps, partner and US health care regulatory leader at Deloitte in Washington.
“They said we’re going to not require quite as much, but the more you do, the better you score,” she said, adding that the CMS knows that technology is a tough requirement for many providers who are still struggling with meaningful use and EHRs. The CMS generally shrunk the required measures under the advanced care information component to ones that practitioners are most familiar with, she said.
“I saw that as mostly a way to provide flexibility,” said Dr. Farzad Mostashari, former national coordinator for health IT and now CEO of Aledade, which establishes and operates physician-led ACOs. The CMS is “moving to a continuum of scoring rather than all or nothing.”
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.
“It’s a return to the original intent, which was that future stages and the final stage of the health IT incentive program be about outcomes,” Mostashari said. “And it’s not so much compliance with a bunch of check-the-box exercises, but using technology to achieve delivery and payment reform goals. The rule takes us a little bit closer to that vision.”
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 rule also finalizes the proposal that it will not require reporting on clinical decision support and computerized provider-order entry in physician EHRs.
“The technology component and the interoperability piece” underpins the law, Phelps said. The tech piece is more than just a reporting exercise. Without an advanced technology platform to share health data across different payment models, it’s difficult to perform well in other parts of MACRA.
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 final rule creates a transitional period in 2017 and 2018 that allows providers to ease into the MIPS program. Only those who don’t send in any data will receive a negative payment adjustment. Providers can receive a small positive adjustment for sending a partial year of data and a slightly larger payment for sending a full year.
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.
New programs that could eventually qualify for the advanced APM track include a new Accountable Care Organization Track 1+ model, Medicare Shared Savings Programs and some bundled payment models.
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.
John Feore, director at Avalere Health, said the changes in the final rule were foreshadowed by an announcement from the CMS last month that providers will be able to avoid negative payments in 2019 by submitting limited data or they can begin submitting the data later and still be eligible for a small pay increase.
“I think that kind of set the stage for providers to understand that CMS was going to be easing into it,” he said.
Practices are likely pleased with the significant burden reduction in the first year of the MIPS program outlined in the final rule, said Dr. Halee Fischer-Wright CEO of the Medical Group Management Association. She was, however, dismayed by the lack of flexibility with compliance.
She said it was disappointing that flexibility provided for quality reporting in 2017 largely disappears in 2018 and beyond. The CMS “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,” she added.
The CMS has renamed the resource use category in MIPS as simply “cost” and it will now carry zero weight in 2017. Feore said this emphasizes quality and eases concern from providers not fully convinced that resource use is an accurate reflection of effectiveness.
The number of measures that must be reported in other categories have been reduced, especially for small and rural providers.
Providers must report up to six quality measures, including one outcome measure, and must attest to having completed four improvement activities.
Danielle Lloyd, vice president of policy and advocacy at the healthcare consulting and group purchasing organization Premier, said the enhanced transitional period will build a stronger foundation for the program and is likely to reinforce and improve the general movement toward value-based payments.
“Transitioning over time to minimize disruption is key to everyone’s success,” she said.
Premier is disappointed that smaller providers cannot join virtual groups that report together. It excludes some clinicians from the program entirely, Lloyd said.
She said that although the nominal risk requirement for advanced APMs was lowered, it is still too high. That is particularly true for health systems because their combined Part A and Part B revenue results in a higher dollar amount.
She said she was glad to see the CMS signaling it will likely include a shared savings program as an advanced APM and applauded the agency’s vow to create more advanced APM options that will transition providers into full participation.
“By adding additional models that qualify we’re hoping that more providers will join them and thus qualify for the 5% bonus,” Lloyd said.” It provides more opportunities for the providers the more models that are out there.”
Overall, providers were pleased that CMS appeared to largely heed their concerns.
“Several provisions will smooth the way for family physicians to participate in the MIPS or APMs,” said John Meigs, President of the American Academy of Family Physicians.
The underrated MACRA effect: Your cost and quality data will be public like never before
A Q&A with Advisory Board expert Austin Weaver
September 23, 2016
CMS this fall is expected to release the final rule to implement the Medicare Access and CHIP Reauthorization Act (MACRA).
What should leaders do now to succeed under the law? And how could the law’s unprecedented transparency provisions change the health care landscape for patients and providers?
The Daily Briefing‘s Josh Zeitlin took those questions and more to Austin Weaver, a senior director with Advisory Board Consulting who has delivered detailed MACRA assessments to organizations of all sizes and types across the country in recent months.
Question: Now that CMS has sent the MACRA final rule to the Office of Management and Budget, the rule could be announced publicly within days or weeks. What will you be looking for when it drops?
Austin Weaver: There are some big questions about how the final rule will differ from what CMS proposed in April, with major implications for providers as soon as next year.
CMS earlier this month in a blog post said it will give providers four options for the pace and level at which they comply with MACRA’s payment reforms in 2017. That announcement provided some answers and some good news for providers worried about the rapid timeline for MIPS—but it raised a lot of questions, too.
For instance, one option CMS outlined will let providers avoid penalties if they submit “some data” to MIPS after Jan. 1, 2017, while another will let providers qualify for bonuses for submitting data for a “reduced number of days.” But how the agency defines “some data” and the number of days will have big implications for what providers choose to do next year.
The final rule also should provide more clarity about how CMS will define a brand-new category that providers will be judged on under MIPS: clinical practice improvement—and what organizations need to do to score well on that metric. It’ll also be interesting to see if CMS makes MACRA compliance any easier for small practices relative to larger ones.
Q: While the final rule will bring more details, what’s your sense right now on how much MACRA will change the way providers do business?
Weaver: There’s both an obvious and a less obvious answer here.
It’s well known that MACRA increases the financial incentives for organizations to participate in value-based care models and take on more risk. That shift is already happening, and MACRA will only accelerate that trend and will get providers to take an even closer look at opportunities to improve on cost and quality.
We’re seeing that now in our conversations with Advisory Board Consulting members. We’ve been working with many organizations to determine their likely performance in the MIPS categories—to identify their strengths, the areas they need to improve on in the short and long term, and how their risk strategies might shift over time.
For example, we’ve found that some providers have a lot of work to do to score well under the MIPS resource use category, which is an example of CMS measuring and basing payment on the cost of care management like never before. There’s lots of potential for providers to leverage data in addressing preventable utilization in the market, and we’ve been talking with them about how to implement best practices in a way that works for them to maximize their payments under MACRA.
Q: What’s the less obvious answer?
Weaver: Well, one effect of MACRA that hasn’t gotten as much attention as it deserves is that the law will bring about a drastically different era of transparency, in which all performance on quality, resource use, and the other scoring categories will be made public for all providers. Most of that information has never been made public before.
That transparency, in which the public will know whether you are considered—rightly or wrongly—to be a low-quality, high-cost provider, is likely going to affect the behavior of health care organizations.
I also think you are going to see these resource use and quality scores become a point of conversation for organizations when they consider their relationships with other providers in the community. It’ll force more scrutiny about whether they make good partners, and it could affect the conversations providers have with payers about their value proposition.
I don’t know whether the new transparency in and of itself will be the main catalyst for those changes, but it will certainly add fuel to the fire. Regardless, the value-based care future we’re moving toward is going to require health care organizations to take a more data-driven approach about which acute and post-acute providers they choose to partner with.
Q: So big changes could be ahead—what should organizations be doing right now to be prepared?
Weaver: Organizations need to really dive in and figure out the areas they need to focus on to succeed under MIPS or the APM track, and what that will entail for their strategies. We help our members with that on a regular basis, including through our on-site MACRA Intensive program.
It’s also important for organizations to figure out as early as possible what quality metrics they are going to report on, as that will drive other important decisions.
The key thing is that, yes, there are some crucial details that will come out in the final rule, but organizations need to be taking action now to set themselves up for MACRA success.
We’ll be talking more about some “no-regrets” steps that will help organizations prepare for MACRA—no matter how the final rule shakes out—in a webconference on Thursday, September 29. It’s open to both members and non-members, so I’d urge people to register now to secure their spot.
Plans for the Quality Payment Program in 2017: Pick Your Pace
By Andy Slavitt, Acting Administrator of CMS (Reprint directly from CMS website September 8 2016)
As the baby boom generation ages, 10,000 people enter the Medicare program each day. Facing that demand, it is essential that Medicare continues to support physicians in delivering high-quality patient care. This includes increasing its focus on patient outcomes and reducing the obstacles that make it harder for physicians to practice good care.
The bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) offers the opportunity to advance these goals and put Medicare on surer footing. Among other policies, it repeals the Sustainable Growth Rate formula and its annual payment cliffs, streamlines the existing patchwork of Medicare reporting programs, and provides opportunities for physicians and other clinicians to earn more by focusing on quality patient care. We are referring to these provisions of MACRA collectively as the Quality Payment Program.
We received feedback on our April proposal for implementing the Quality Payment Program, both in writing and as we talked to thousands of physicians and other clinicians across the country. Universally, the clinician community wants a system that begins and ends with what’s right for the patient. We heard from physicians and other clinicians on how technology can help with patient care and how excessive reporting can distract from patient care; how new programs like medical homes can be encouraged; and the unique issues facing small and rural non-hospital-based physicians. We will address these areas and the many other comments we received when we release the final rule by November 1, 2016.
But, with the Quality Payment Program set to begin on January 1, 2017, we wanted to share our plans for the timing of reporting for the first year of the program. 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 January 1, 2017. During 2017, eligible physicians and other clinicians will have multiple options for participation. Choosing one of these options would ensure you do not receive a negative payment adjustment in 2019. These options and other supporting details will be described fully in the final rule.
First Option: Test the Quality Payment Program.
With this option, as long as you submit some data to the Quality Payment Program, including data from after January 1, 2017, you will avoid a negative payment adjustment. 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.
Second Option: Participate for part of the calendar year.
You may choose to submit Quality Payment Program information for a reduced number of days. This means your first performance period could begin later than January 1, 2017 and your practice could still qualify for a small positive payment adjustment. 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. You could select from the list of quality measures and improvement activities available under the Quality Payment Program.
Third Option: Participate for the full calendar year.
For practices that are ready to go on January 1, 2017, you may choose to submit Quality Payment Program information for a full calendar year. This means your first performance period would begin on January 1, 2017. For example, if you submit information for the entire year on quality measures, how your practice uses technology, and what improvement activities your practice is undertaking, you could qualify for a modest positive payment adjustment. 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.
Fourth Option: Participate in an Advanced Alternative Payment Model in 2017.
Instead of reporting quality data and other information, the law allows you to participate in the Quality Payment Program by joining an Advanced Alternative Payment Model, such as Medicare Shared Savings Track 2 or 3 in 2017. If you receive enough of your Medicare payments or see enough of your Medicare patients through the Advanced Alternative Payment Model in 2017, then you would qualify for a 5 percent incentive payment in 2019.
However, you choose to participate in 2017, we will have resources available to assist you and walk you through what needs to be done. And however you choose to participate, your feedback will be invaluable to building this program for the long term to achieve outcomes that matter to your patients.
We appreciate the sincere and constructive participation in the feedback process to date and look forward to advancing step-by-step in that same spirit. We look forward to releasing the final details about the program this fall. Most importantly, we look forward to further engagement with physicians and other clinicians toward our shared goal of the highest quality of care and best outcomes for patients.
- If you wish to review more details received during the comment period, connect to the link below:
Survey finds half of physicians have never heard of MACRA
Centers for Medicare & Medicaid Services Acting Administrator Andrew Slavitt made some major news Wednesday when he told members of a senate committee the agency is considering a delay in the January 1 start date for MACRA. He got another reason to do just that with the release of a survey that found half of physicians have never heard of MACRA, a law that will fundamentally change how physicians are reimbursed under Medicare.
In a survey of 600 physicians, the Deloitte Center for Health Solutions, found while many doctors have never heard of MACRA, most physicians will have to change aspects of their practice to meet the law’s requirements and do well under its payment system. If CMS doesn’t delay the January 1 start date for the first reporting period, “the fact that so many physicians and clinicians still haven’t heard of the law means they’ll have a lot of work to do over the next five months,” said Anne Phelps, principal at Deloitte & Touche LLP, in a survey announcement.
Concerns that many physicians, especially those in small and rural practices, are not ready to implement MACRA changes is a major reason why CMS may consider a delay, Slavitt told members of the U.S. Senate Finance Committee yesterday.
The American Medical Association, which is among many physician organizations urging CMS to delay MACRA, was heartened by Slavitt’s “consideration of options that include an alternative start date, shorter reporting periods and finding other ways for physicians to get experience with the program in the early stages of implementation,” said its President Andrew W. Gurman, M.D., in an announcement. “Successful implementation will require flexibility, and indications are that CMS intends to work toward the goal of giving physicians a fair shot in adjusting to this new policy framework.”
MACRA will give physicians two payment options: the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APM). In a study by the Brookings Institution, researchers said physicians who are consistently high performers would earn more in Medicare reimbursements under MIPS than with other alternative payment models. In theory, even physicians in an APM who are confident they will score well on quality and value metrics might be better off being judged under MIPS, the report said.
But with only six months to go before the possible start date when physician performance will have an impact on Medicare payments, “most [physicians] are confused about how best to navigate the various programs given the complexity of the rules and options,” the researchers concluded. CMS is currently reviewing more than 3,800 comments on its proposed rule and is expected to release a final rule this fall.
Slavitt suggests MACRA could be delayed
By Shannon Muchmore | July 13, 2016
CMS Acting Administrator Andy Slavitt told lawmakers Wednesday that the agency is considering delaying the start date for Medicare payment reform, which is set to go into effect Jan 1.
Testifying before the Senate Finance Committee, Slavitt said the CMS is concerned that some physicians, particularly at small practices, may not be ready for the changes under the Medicare Access and CHIP Reauthorization Act that replaced the much-maligned sustainable growth-rate formula.
Several medical groups, including the American Medical Association, the American Academy of Family Physicians and the Medical Group Management Association, have encouraged the CMS to delay MACRA.
In his opening testimony, Slavitt said the CMS is open to alternative measures that will achieve the agency’s objectives, which include patient participation and reducing reporting burdens for practices.
Senators continued to show great concern for small and rural practices, which have said MACRA could force them to join hospitals or larger practices because of the paperwork and payment changes required.
Slavitt said the CMS is aware of these potential conflicts and also concerned. The CMS has received “significant feedback”, Slavitt said. “Some of the things that are on the table, (that) we’re considering include alternative start dates, looking at whether shorter periods could be used, and finding other ways for physicians to get experience with the program before the impact of it really hits them.”
“The focus on small independent practices and their ability to continue practicing independently is a very important priority for us,” he said.
Slavitt also said methods of gathering data other than provider reports could help doctors focus on patient care. Some information could be gathered from automatic data feeds.
Senators asked about methods from reimbursing chronic care patients and those seeking advanced care directives. Slavitt said the CMS is looking to expand methods for reimbursing providers at higher rates for chronic patients, as was recently implemented with Medicare Advantage.
He also suggested further encouraging alternative payment models such as bundling, medical homes and team-based and prevention models.
“We need to get out of the mode of paying physicians just to run tests and prescribe medicines,” he said.
WASHINGTON — Physicians are likely to be hurt by the legislation passed to repeal Medicare’s “Sustainable Growth Rate” reimbursement formula, several experts said at a briefing here Thursday June 23rd, addressing the Medicare Trustees’ Report, in a meeting sponsored by the Brookings Institution and the American Enterprise Institute (AEI).
“Doctors are going to be livid when they absorb the fact that they spent so much political capital to enact MACRA [the Medicare Access and CHIP Reauthorization Act] only to find out … that under the current payment system, doctors are going to get paid less; that gap will grow over time,” said Robert Moffit, PhD, senior fellow in the Center for Health Studies at the Heritage Foundation, a right-leaning think tank here. “When they absorb that fact, I think we’re going to see more trouble on Capitol Hill over physician payment.” Reported by Joyce Frieden, News Editor, MedPage Today