Other changes under consideration include increasing the number of physicians excluded from quality reporting and allowing some to use “automatic” data-reporting techniques.

July 13—Amid a crush of concerned feedback from providers, Medicare is considering delaying the January 2017 start of data collection under its new physician payment system, according to the agency’s leader.

Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services (CMS), told a congressional committee Wednesday that CMS is considering delaying implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The proposed rules would require most physicians paid under Medicare to begin tracking various quality indicators on Jan. 1, 2017.

CMS officials “remain open to multiple approaches,” Slavitt said in testimony to the Senate Finance Committee. “So, some of the things that are on the table, 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.”

A CMS spokesman declined to provide any details of the possible implementation delays under consideration.

Many individual providers and organizations had urged delays in the start of MACRA reporting. For instance, the Medical Group Management Association (MGMA) urged in its comment letter that CMS push back the start of quality reporting to January 2018.

Slavitt said calls for delay were a “significant” part of the feedback CMS has received from physicians on the proposed rule implementing MACRA. Nearly 4,000 comments have been submitted, and 64,000 attendees have participated in more than 200 MACRA discussion sessions through CMS.

Sen. Orrin Hatch (R-Utah), chairman of the committee, echoed many of those physician concerns when he said release of a final rule for MACRA around Nov. 1 would give physicians only two months to prepare for the start of data collection. Hatch noted that the MACRA statutory language allowed “flexibility” on when quality-data reporting needs to start.

Other Changes Possible

Slavitt noted that many of the comments have specifically highlighted concerns that small and independent practices would have a hard time meeting the new quality-reporting requirements of MACRA. Physicians who fail to meet quality-reporting thresholds under one of the two MACRA tracks—which is expected to include most physicians—will face cuts of up to 9 percent of their total Medicare payments in future years.

Other changes under consideration to address those challenges include the possibility that all reporting could be eliminated for some physicians.

“We have some categories where we can get automatic data feeds from physicians and don’t need to ask them to report,” Slavitt said.

Other quality-reporting areas may be dropped because physicians already are performing well in them, Slavitt said.

The agency also is examining the thresholds that would exempt physicians who treat only a small share of Medicare patients from having to report quality data. The statute required CMS to exclude physicians with few Medicare patients, which CMS defined as clinicians and groups that have Medicare billing charges of $10,000 or less and provide care to 100 or fewer Medicare Part B beneficiaries.

“There are a variety of ideas that have been coming to us, and they are all on the table at this point,” Slavitt said.

More Feedback

Slavitt said CMS also is considering issuing an interim final rule, which would allow continued physician feedback, as opposed to a standard final rule.

“We know that this is a long-term process,” Slavitt said about MACRA implementation. “We know that we are only taking the first step in the first year of implementation, so we have to have the processes that allow physicians to continue to provide feedback to us.”

That sort of regulatory approach was urged by the American Academy of Family Physicians (AAFP), among others.

“We recognize that extending the regulatory process prolongs both the work of CMS staff and prevents full-scale implementation, but we feel an additional comment period, on balance, would be justified by the long-term success of the program,” AAFP wrote in its MACRA comment letter.

Among other areas where Slavitt said CMS has received extensive feedback was regarding the MACRA rule’s definition of advanced alternative payment models (APMs). Many organizations, including MGMA and individual accountable care organization (ACO) members, have criticized the proposed rule for excluding Medicare Shared Saving Program Track 1 ACOs from designation as qualifying APMs. Physician members of qualifying APMs do not need to participate in MACRA’s complex quality reporting and earn 5 percent annual bonuses.

Excluding Track 1 MSSP ACOs, Bundled Payment for Care Improvement (BPCI) and Comprehensive Care for Joint Replacement (CJR) models, and accredited medical home models “would significantly undermine the efforts of these models, which have been at the forefront of risk-bearing arrangements and promoting health outcomes through better care coordination and quality,” Halee Fischer-Wright, MD, president and CEO of MGMA wrote in the association’s comment letter.

One APM-qualifying model, Medicare’s Oncology Care Model (OCM), which started this month,  garnered nearly 200 physician group practice participants—or about twice as many as expected. Some industry advisors cited MACRA’s APM push as the likely reason for the high volume.

Rich Daly is a senior writer/editor in HFMA’s Washington, D.C. office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Wednesday, July 13, 2016