Physician advocates expect to continue pushing for MACRA changes, including ways it attributes patients to clinicians.

Nov. 3—Physicians should report at least one quality measure or one improvement activity to avoid penalties in 2017 under a sweeping new physician Medicare payment law, advised officials representing medical practice management.

“You may feel like this is a big transition, but you've been doing this work for years,” Jennifer McLaughlin, senior associate director for governmental affairs for the Medical Group Management Association (MGMA), said during the group's recent annual conference.

McLaughlin was referring to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which overhauled Medicare physician payments starting in 2017 to move to more value-based models.

Avoiding Penalties

The final rule governing MACRA, which was released in October, offers “pick your pace” options that can allow physicians to gradually enter the program.

Specifically, next year, most physicians who are required to participate in the new payment scheme will be able to report just one quality measure for one patient one time (or one improvement activity or electronic health record measure) in order to avoid a 4 percent penalty, McLaughlin said.

About 45 percent of practicing clinicians will be required to participate in MACRA because they receive Medicare Part B payments, according to MGMA. The other 55 percent of physicians are excluded because their practices are too small; they don't take Medicare payments; or they receive only hospital (Medicare Part A) payments. Providers in their first year of billing Medicare also are exempt.

Physicians have two tracks to participate in MACRA, which has been rebranded the Quality Payment Program. The two tracks are a Merit-based Incentive Payment System (MIPS) or an advanced Alternative Payment Model (APM).

The vast majority of clinicians will go into MIPS, as only about 10 percent of clinicians are expected to quality for APM status in 2017, officials at MGMA said.

The Centers for Medicare & Medicaid Services (CMS) has moved all prior quality and meaningful use staff and programs under one MIPS umbrella internally, McLaughlin said, which eases navigation of the system and allows quick responses from the agency on questions or clarifications as they arise.

While most physician practices won't join APMs in 2017, CMS recently announced there would be more opportunities to participate in future years with additional APMs coming online, said Anders Gilberg, senior vice president of governmental affairs for MGMA.

For most physicians, however, the “pick your pace” feature of MIPS quality reporting is feasible, MGMA officials said.

“You can literally do what you want,” McLaughlin said. “You can avoid the four percent penalty by reporting one measure, one time for one patient. Or you can try to score higher in MIPS and then there will be more rewards."

Future Changes

Provider advocates in Washington continue to seek more clarity on the details of the law and its newly released final rule. “Even though the document is 2,400 pages long, it is a living, breathing document,” McLaughlin said. “There's always going to be evolution."

Providers should not expect to see any massive changes or a repeal, however, as a result of the presidential election outcome, Gilberg said.

“This was a bipartisan piece of legislation,” Gilberg said. “The only thing that often changes is an interruption at the (CMS) leadership level,” because of new appointees.

Issues that MGMA is watching closely related to MACRA include whether practices will be evaluated based on costs. In 2017, payments in MIPS are based on quality (60 percent), electronic health record implementation (25 percent), and improvement activities (15 percent).

Another hot issue is patient attribution methodologies, McLaughlin said. This means designating which physician must be accountable for patients who move around or are referred from elsewhere, or based on various levels of interaction with that patient.

“We will be able to go back to Congress or to the administration,” on this issue, McLaughlin said. Patient attribution methodologies are expected to go into effect in 2018, she added.

MGMA, along with other provider interest groups, pushed back on initial proposed rule for MACRA, and got some of what they asked for. McLaughlin called the proposed rule a “dramatic overreach” of the law's intent. 

“The agency really did mitigate those concerns,” McLaughlin said. For instance, the proposed rule called for a full calendar year of reporting data in MIPS. MGMA wanted instead a statistical sample or any 90-day period. The final rule includes a 90-day reporting option for 2017.

Gridlock will likely continue in Washington, as well as regulatory inertia on many issues, MGMA officials told the audience. MACRA is a rare opportunity to move forward on physician payment reform.

“We're talking about an opportunity to modernize the payment system,” McLaughlin said. “It's going to be awkward at first.”

Rebecca Vesely is a freelance writer based in San Francisco. Follow her on Twitter at @rebvesely.

Publication Date: Friday, November 04, 2016