CMS says they will send out MIPS status information—promised in December—in the spring.


March 24—The move from volume- to value-based physician payment has started. But federal regulators have yet to provide critical information to physicians.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repealed Medicare’s sustainable growth rate (SGR) payment formula and created new value-based Medicare Part B payment systems, including the Merit-based Incentive Payment System (MIPS) and designated advanced alternative payment models (APMs).

MACRA requires physicians this year to file quality reports, which affect payment for 2019.

But many physicians and group practices are still unsure of how to get started as at least a third of physicians may be exempt from MIPS reporting. The Centers for Medicare & Medicaid Services (CMS) promised that it would notify physicians about their MIPS status by December, but the agency has yet to fulfill that promise.

The Medical Group Management Association (MGMA) wrote a letter to CMS Administrator Seema Verma asking that the agency “expeditiously release” the eligibility notices. The MGMA also requested the agency do the same with a promised list of approved vendors that operate qualified registries and qualified clinical data registries with which physicians can partner to meet data-reporting requirements.

“Group practices planning to utilize these reporting mechanisms must either delay engagement or partner with vendors without a guarantee they meet CMS’s qualifications,” Anders Gilberg, MGMA senior vice president for government affairs, wrote in the letter to Verma.

380,000 Clinicians Affected

Physicians who earn less than $30,000 annually from Medicare or who serve fewer than 101 beneficiaries will be exempt for MACRA quality reporting. Citing CMS figures, Gilberg wrote that about 32.5 percent of Medicare providers—or about 380,000 “eligible clinicians” (ECs)—will not meet those thresholds and thus will be exempt. Lower reporting requirements also have been set for ECs deemed “hospital-based” or “non-patient-facing,” but Gilberg noted that physicians have not been notified about whether they qualify for that status either.

“Groups are calling us and asking ‘How should we report?’” Gilberg said in an interview. “If you don’t even know which clinicians in your group are eligible, you can’t organize your practice strategy.”

Gilberg noted that, for example, physicians in an OB-GYN practice may have wide variation in the number of Medicare patients they see. Also, practices may be organized differently in terms of combinations of group or individual National Provider Identifiers and Tax Identification Numbers . All of these could affect exemption status and how a practice reports its data.

CMS has created alternate paths for MACRA reporting with its “Pick Your Pace” approach, so minimal effort can be expended to avoid a penalty in the first year, but the lateness of notification makes it difficult for those who invested for success in the program and were aiming to earn a bonus, Gilberg said.

“It’s not the end of the world,” he said. “But if CMS cannot do something as fundamental as tell physicians whether or not they are eligible, there are far more complicated issues to come.”

‘Growing Pains’

Gilberg’s point about the program’s complexity was echoed by Larry Kocot, a principal with healthcare consultant KPMG and national leader of its Center for Healthcare Regulatory Insight. Kocot also noted that the program is sure to suffer “growing pains,” but CMS has to ensure that its starts off this new era with accurate data.

“It sounds pretty simple but, if that physician is going through a group [to report] there are a lot of nuances that might compromise what CMS thought was a good data set—they don’t want to tell a physician they don’t have to report when they actually do,” Kocot said in an interview. “Also, from a technical operation standpoint, this was destined to be more complicated than the legislation and regulation ever envisioned.”

A CMS spokesperson said in an email that the agency will be replying to the MGMA letter and is committed to notifying physicians this spring about their status under MIPS. CMS is working with clinicians to ensure that the information it sends out is understandable, actionable, and useful to their decision-making process, the spokesperson said.

Gilberg questioned how information sent out in the spring of the reporting year will be useful for planning how to organize a 2017 strategy.

“All physicians want is to understand the rules ahead of time,” he said. “Physicians want to know the rules of the game before the game started—not in the second quarter.”

Still Time

Kocot speculated that the change in presidential administrations from Barack Obama to Donald Trump may have slowed the process down, but added that the onus is on CMS to find a workable solution because it told physicians it was going to issue information on exemption status and qualified registry vendors in December.

“CMS created this situation by not following their own regulation, and it will have to deal with physicians who have been harmed,” Kocot said.

But he also explained that MIPS reporting is staggered in such a way that deadlines can be extended. Because this year’s reporting won’t affect payment until 2019, “CMS has some time to figure it out,” he said. Surveys by HFMA and others show varying degrees of readiness for MIPS and value-based payment programs. But Kocot said surveys could be deceiving and the questions being asked may not accurately reflect all the nuances involved.

“I think more and more physicians are ready every day,” Kocot said.

He added that Tom Price, MD, a former orthopedic surgeon and now the secretary of the US Department of Health and Human Services (HHS), may provide a sympathetic ear in the Trump administration form physicians.

Price is aware of the regulatory burdens doctors are facing and wants them to succeed under MACRA, Kocot said.

“If there is a remedy, I’m sure he’s already considering it,” Kocot said.


Andis Robeznieks is a freelance writer based in Chicago. Follow Andis on Twitter at @AndisRobeznieks

Publication Date: Friday, March 24, 2017