Slavitt: CMS is considering MACRA delay

Slavitt cites concerns for rural, small practices

Read Advisory Board's take on this story.

Acting CMS Administrator Andy Slavitt during a Senate Finance Committee hearing on Wednesday said the agency is considering pushing back the start date for payment reforms called for under the Medicare Access and CHIP Reauthorization Act (MACRA).

MACRA will fundamentally change how Medicare pays physicians and other clinicians who participate in the program. The law will establish a two-track system for Medicare reimbursement: one, called the Merit-based Incentive Payment System (MIPS), for providers who are reimbursed largely through fee-for-service, and an alternative payment model (APM) track for physicians who take on a significant portfolio of APMs.

CMS in April proposed to use 2017 as the performance year for determining clinician payment adjustments in 2019 under both payment tracks.The agency proposed starting the performance period on Jan. 1, 2017.

Provider organizations and other stakeholders have raised concerns with the program's complexity, short implementation timeframe, and potential effects on small and rural providers.

Your questions about the MACRA proposed rule—answered

Slavitt says CMS could delay some MACRA changes

During the hearing, Slavitt said CMS is concerned that some physicians, particularly at small physician practices, might not be prepared for the MACRA changes set to take effect next year. As a result, he said CMS is considering altering the start date, adding that MACRA's changes need to "begi[n] on the right foot, so every physician in the country feels that they are set up for success."

Slavitt also said CMS is considering publishing an interim final rule this fall to allow the agency to receive additional feedback. He explained, "We know this a long-term process, and this is just the first step. CMS needs to shorten the window and close the gap between the practice of medicine and policy implementation. This process allows us to get closer to that."

Further, Slavitt said CMS is open to alternative strategies to achieve the agency's objectives under MACRA. He stated, "There are a variety of ideas that have been coming to us, and they're really all on the table at this point."

Will MACRA make physicians even more accountable for cost and quality?

For example, Slavitt said CMS is considering shorter reporting periods and allowing physicians to implement MACRA changes before the "impact ... really hits them." In addition, Slavitt said CMS is considering expanding different ways to reimburse providers at higher rates for patients who require chronic care.

Slavitt also said CMS is looking to further encourage the use of APMs, including bundled payments, medical homes, and prevention and team-based APMs. He stated, "We need to get out of the mode of paying physicians just to run tests and prescribe medicines" (Muchmore, Modern Healthcare, 7/13; Owens, Morning Consult, 7/13; Leventhal, Healthcare Informatics, 7/13; American Health Line, 6/29 [subscription required]).

Advisory Board’s take

Ingrid Lund, Physician Practice Roundtable

Slavitt's comments to the committee suggest that MACRA could theoretically be delayed; whether or not that will happen is still very much up in the air.

However, even if MACRA is delayed, providers should not ease up on their preparation efforts.

Because MIPS, the payment track most providers will fall into, is revenue-neutral, the program will produce winners and losers—making it crucial that providers act now to prepare. Achieving a score in the top of the pack will only become more difficult as other providers make investments and develop the necessary reporting capabilities. There is a clear first-mover advantage here.

Further, organizations will likely need to undergo significant operational practice changes to achieve high performance scores and earn payment bonuses in MIPS.

A delay would provide reprieve for the many providers who are feeling behind, but organizations should take the opportunity to move forward with their preparations now so that when MACRA does kick in, they're set up for success.

To learn more about how to set your organization up for MACRA success, join us for today’s webconference on the ins and outs of how MACRA will affect your health care organization. 

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