MACRA penalties can now be avoided, CMS says

Troy Parks
Staff Writer
AMA Wire
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Avoiding penalties under the Medicare Access and CHIP Reauthorization Act (MACRA) just got easier. The Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt Thursday announced that the final MACRA regulation will exempt physicians from any risk of penalties if they choose one of three distinct reporting options in 2017.

In a blog post, Slavitt announced that CMS heard physicians’ concerns about the proposed start date for performance reporting under the new Medicare payment system and that the agency will offer three reporting options for the Merit-based Incentive Performance System (MIPS)—and if you choose one for 2017, you will not receive a negative payment adjustment in 2019.

The options will be described fully in the final rule, but here are the basics:

  • Option one: Test the program - As long as you submit some data to the Quality Payment Program, including data from after Jan. 1, you will avoid a negative payment adjustment, Slavitt said. This option is intended to ensure that the system is working and that physicians are prepared for broader participation in the coming years as they learn more.
  • Option two: Partial-year reporting - Physicians can choose to report Quality Payment Program information for a reduced number of days. Your first performance period could begin well after Jan. 1 and your practice could still qualify for an incentive payment. Slavitt offered an 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,” he said, “you could qualify for a small positive payment adjustment.”
  • Option three: Full-year reporting - If your practice is ready to get started on Jan. 1, you can choose to report Quality Payment Program information for the full calendar year. Your first performance period would begin on Jan. 1, and if you submit information for the entire year your practice could qualify for a modest positive payment.
  • Advanced Alternative Payment Model (APM) option - This option is still available and qualified participants in advanced APMs will be eligible for five percent incentive payments in 2019.

Choosing any of these options guarantees that you will not receive a negative payment adjustment.

The announcement confirms that physician input is playing a critical role in the development of the final MACRA rule. Slavitt stated his appreciation for the constructive participation of physicians in the feedback process and added that CMS looks forward to further engagement with physicians to make sure the new Medicare payment system works for everyone, including patients.

"By adopting this thoughtful and flexible approach, the Administration is encouraging a successful transition to the new law by offering physicians options for participating in MACRA,” said AMA President Andrew W. Gurman, MD, in a statement commending Slavitt and Department of Health and Human Services Secretary Sylvia Mathews Burwell.

“This approach better reflects the diversity of medical practices throughout the country,” he said. "The AMA believes the actions that the Administration announced today will help give physicians a fair shot in the first year of MACRA implementation.”

This kind of flexibility is what physicians were seeking throughout the draft rule comment period—and now it is a reality. The only way to receive a negative payment adjustment now is by not participating at all.

More resources and tools are provided by the AMA are available to help your practice navigate Medicare payment reform.

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Comments

Ah Doctors...idiot savants...THERE SHOULD NEVER BE MACRA. Do you have the power to rid medicine of governmental destruction? Yes you do. Stop practicing until they are gone. Do not recite the Hippocratic Oath since the government through that out years ago. Democratic approach to everything is 'divide and conquer' that means DIVIDE the 'doctor/patient relationship' and easily conquer both. Evaluate yourselves. NEVER trust the government doing ANYTHING. Restore medicine as it should be. Right now the patients hate it and the government keeps telling them that it is THE DOCTOR who is responsible. Idiot savants.
USA has by far the highest cost of healthcare and yet by many healthcare parameters are way down among economically developed nations in terms of the quality and effectiveness of that healthcare. This program represents an effort to improve the quality of healthcare purchased by your tax dollar. So does that mean that anyone interested in improving the quality of care is an idiot?<br/> Two observations:1) is the best way to present an argument amongst supposedly intelligent persons to do so by name-calling? Do you really think that I'm an idiot ?<br/> 2) Sometimes, for positive change one has have the flexibility to step beyond their long-held sacred beliefs that in some situations impedes efforts of improvement.<br/> Ray Jacobson, M.D.
We're getting boned quite as thoroughly by private insurance companies as by the government. We screwed ourselves when we handed the reins over to the MBAs and bean-counters. Many docs in my specialty (psych) have dropped Medicare and moved to a fee-for-service model. I am seriously considering doing the same.
rayjay, if you think this is an improvement then who is really hanging on to their sacred beliefs? Obamacare is a total disaster. If you are truly objective I believe you would agree. This argument about trying to be like other nations is a crock. The statistics are almost always biased against the USA with their inclusion criteria. I will hold on to Liberty because it is sacrad. I don't trust the federal government with running something as important as healthcare.
Delaying a bad law by one year is not a victory. Not being fined for one year while payments fall further behind escalating overhead costs is not what physicians want. Physician payments under MACRA will increase at a slower rate than they did with the SGR patches. As a budget neutral program, any bonuses that practices manage to get will come at the expense of other physicians. The rewards will not necessarily go to those practicing better medicine, but to those who are better able to present data in the manner desired by the Feds.
This has to be a shared responsibility between the physicians, government, Pharma, device manufacturers, insurance companies and other healthcare providers in the continuum. The train has left the station. Staying with volume based reimbursement to drive income is not going to work. Employers can't afford to provide benefits as the cost of healthcare has skyrocketed and most have shifted the burden to the employees. This is unsustainable at both a private and federal level. Patient care will suffer as those who cannot afford it will put off valuable screenings and preventive services. The market will drive down pricing as patients shop for services they can afford in their high deductible plans. Agreed the proposed regs. have their flaws and no one likes a zero sum game but the industry must come to grips with moving toward value and efficiency. Fee for value versus fee for service. I have worked in large hospital systems and large physician practices and in my experience it has been a challenge to get physicians to truly understand the drivers of healthcare costs and to participate in developing solutions. That is not meant to be disrespectful in any way. Incentives need to be aligned. The bundling programs will force the issue but the results are years away.
I smell a rat, and the rat is the Federal bureaucracy. Meaningful Use has become Meaningless Use. Since when does the government determine what the quality of care is for the patient. What about the patient paying for and determining what they want/ and get from their doctor. Have the government go after the criminals in our profession ( as well as in others, such as politicians, and bureacrats, etc.). Medicine is still a free enterprise endeavor in the U.S., although there are many of our collegues who would have us go into a government controlled Socialist system. Get rid of the bloat in government, the waste, the excessive entitlement give aways, and stimulate our economy by lowering taxes and the corporate tax rate, and pay down the national debt. Then we'll have more than enough money to care for Medicare and Medicaid.
Healtchareisevolving: I understand your concerns. I also mean no disrespect, but your perspective is limited by your experience in large groups. Those businesses generally have large administrative and facility overheads, which have been covered by a combination of government support (facility fees) or generating charges by stressing production, or volume. Those with their own labs and inpatient facilities encourage utilization of those services, further driving up the cost of health care. The most cost effective way to practice has been the small single specialty clinic, which is being driven out of existence by this misguided attempt to increase the efficiency of large groups by increasing the administrative burden of practicing medicine. Those valuable screening studies that have been declared cost free to the public are one reason that insurance premiums and deductibles Have skyrocketed; the insurance industry passes their increased costs on to the consumers. The train has left the station, but it's headed down the wrong track.
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Mar 22, 2017
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