Why some fear MACRA could be 'the next SGR'

'It could be a big step in the right direction, or it could be the next [Sustainable Growth Rate],' Harvard professor says

Many industry groups have praised CMS' efforts to reduce clinicians' burdens in the MACRA final rule, but some stakeholders are concerned the agency has gone too far—and that it might continue to delay certain requirements in future years.

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CMS on Friday released its final rule to implement new value-based payment programs under the Medicare Access and CHIP Reauthorization Act (MACRA).

The rule establishes the Quality Payment Program (QPP), under which eligible professionals will choose from two quality reporting paths: the Advanced Alternative Payment Model (APM) track, for clinicians who take on a significant portfolio of APMs; and the Merit-based Incentive Payment System (MIPS), for providers who are reimbursed largely through fee-for-service.

Additional flexibility draws some concerns

CMS made several changes between the MACRA proposed rule and final rule to simplify requirements and provide additional flexibility for clinicians. For instance, clinicians will:

  • Have new options for the pace and level at which they comply with MACRA's payment reforms in 2017, including an option for providers to report only a single metric;
  • Be able to satisfy reporting requirements by reporting for a 90-day period, rather than for a full year, as CMS had originally proposed; and
  • Not be scored on the resource use category in 2017.

CMS acting Administrator Andy Slavitt on Friday said, "We're not looking to transform the Medicare program in 2017. We're looking to make a long-term program successful."

The agency cautioned providers that "in future years of the program, we will require longer performance periods and higher performance in order to avoid a negative MIPS payment adjustment."

Still, some stakeholders expressed concern that CMS might continue to kick certain requirements down the road in future years, like it has done with the meaningful use program, David Pittman reports for Politico Pro.

Frank Micciche, VP of public policy at the National Committee for Quality Assurance, told Politico Pro that CMS needed to make 2017 a transition year for MIPS. However, he added, "If we're having the conversation two years, or three years or four years from now, about why they are continuing to put off or water down requirements, then I think it's a big concern."

Katherine Baicker, a professor of health economics in Harvard T.H. Chan School of Public Health's Department of Health Policy and Management, told Politico Pro that it was too soon to know if CMS' went too far in providing flexibility. "It could be a big step in the right direction, or it could be the next [Sustainable Growth Rate]," she said.

Other stakeholders praised the added flexibility from CMS. American Medical Association President Andrew Gurman said in a statement that the group's "initial review indicates that CMS has been responsive to many of the concerns raised by the AMA," including by giving clinicians more ways to comply with MACRA in 2017.

Other MACRA reactions

Several other groups praised aspects of the final rule while also suggesting additional changes.

Tom Nickels, the American Hospital Association's (AHA) EVP for government relations and public policy, praised CMS for proving "clinicians with increased flexibility to meet MACRA's aggressive timelines and reporting requirements."

How you can leverage health IT to achieve MACRA success

However, Nickels said AHA is "disappointed that CMS continues to narrowly define advanced [APMs]" but is "encouraged that CMS is exploring a new option that would expand the available advanced APMs that qualify for incentives." He added that "AHA remains concerned that the lack of sociodemographic adjustment to the measures used in the MIPS will unfairly disadvantage clinicians and hospitals caring for the poorest patients."

Halee Fischer-Wright, president and CEO of the Medical Group Management Association, also applauded CMS for providing more flexibility, but added, "It's disappointing that flexibility provided for quality reporting in 2017 largely disappears in 2018 and beyond." Fischer-Wright also said, "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 incentive" (Rappleye, Becker's Hospital Review, 10/14; Pittman, Politico Pro, 10/14 [subscription required]; Dickson et al., Modern Healthcare, 10/14; AHA statement, 10/14).

How the MACRA final rule will affect providers

Join Advisory Board experts for webconferences on Friday, October 28 and Tuesday, November 1 as they break down key implications of the final rule to implement MACRA.

You'll learn he basic framework CMS plans to use to implement MACRA in 2017, the most important changes in the final rule, and mext steps for provider organizations in response to MACRA.

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