CMS grants docs reprieve from MACRA implementation

CMS announced that it will allow providers to pick their implementation pace for the Medicare Access and CHIP Reauthorization Act (MACRA) that begins January 1, 2017, and healthcare executives should use this bit of breathing room to their advantage, according to experts.

Related: Eleven ways MACRA will impact your business

Belokrinitsky

“The announcement is the next round of a conversation between the physician community and the CMS, in an effort to produce a better policy. More changes are possible,” says Igor Belokrinitsky, principal with strategy&, PwC’s strategy consulting business, and with PwC U.S. “The announcement relaxes some of the pressure by allowing physicians more flexibility and the ability to kick the tires and become more comfortable with the inputs and outputs of the process in 2017.”

During 2017, eligible physicians and other clinicians will choose one of four options for participating, including testing the payment option, participating for part of the calendar year, participating for the full calendar year or joining an Advanced Alternative Payment Model (APM), such as Medicare Shared Savings Track 2 or 3 in 2017. 

The previous version of the rule placed a lot of emphasis on 2017 as the year when the performance measurement would begin, with the payments for 2017 performance occurring in 2019. Choosing one of these options would ensure you do not receive a negative payment adjustment in 2019, according to CMS. These options and other supporting details will be described fully in the final rule on November 1.

“More specifically, physicians can choose to test the program, without fear of a negative payment adjustment,” Belokrinitsky says. “Physicians can also choose to participate for only a part of the year or for the entire year, or, for the most advanced practices, pursue the Advanced [Alternative] Payment Model. Most practices are expected to choose the alternative to the AMP, called the Merit-Based Incentive Payment System [MIPS].”

Next: Implications for execs

The biggest implication for executives is more breathing room to rally their physicians, test their system readiness, and accelerate the rollout of key analytical, administrative and clinical capabilities, says Belokrinitsky.

“Overall, MACRA rewards ‘system-ness’ by asking all physicians in a practice to report in a consistent fashion, collaborate and use technology,” he says. “Under MACRA, physician organizations will get more benefit out of their shared services as they help track, analyze and report current performance, verify physicians’ historical performance-which impacts today's payments-and validate the performance scores posted by the CMS before they are made public or used to determine reimbursement. MACRA should also improve the ROI of the investments that practices are making in population health capabilities.” 

This reprieve likely means performance will be higher, according to Belokrinitsky. “Since CMS uses a relative methodology, higher overall performance will be the likely outcome,” he says.

Rizk

This latest change from CMS continues to emphasize the importance and emphasis the healthcare system will have on quality, says Emad Rizk, MD, CEO of Verscend Technologies.

"I applaud CMS with the recent 'pick your pace' options of MACRA. CMS is creating more flexibility, telling providers that they can start participating in some way. With these new options, CMS shows a willingness to work with all constituents in healthcare, and will set money aside to develop quality indicators," Rizk says. "That said, it’s clear that quality and performance are critical measurements and the industry needs to get on board. Delivery systems, whether stand alone or part of a large institution, need to fully understand their quality metrics, and where they stand in terms of their peers. They also need to ensure that they have the solutions, processes, and protocols in place to identify opportunities to continually improve the quality of care they deliver. There is still time for CMS to make more adjustments. We’ll have to wait and see what the final rule dictates."

Related: MACRA will drive value-based reimbursement momentum