Other as-yet-unreleased MACRA information includes determinations on whether some physicians are viewed as hospital-based or non-hospital-based.


May 12—Federal officials say only about one-third of clinicians will have to file quality reports this year under the new Medicare payment system, according to multiple news reports.

News outlets reported that officials at the Centers for Medicare & Medicaid Services (CMS) said 418,849 clinicians must participate in 2017 quality reporting to avoid penalties under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Another 806,879 clinicians won't have to comply with MACRA reporting requirements.

CMS did not respond to emails seeking confirmation of those figures. The share of clinicians required to participate is fewer than CMS’s estimate, issued last year, of 642,000. The number excluded from the requirements exceeds the estimate of 780,000.

MACRA splits clinician payment models into two tracks, either the Merit-based Incentive Payment System (MIPS) or advanced alternative payment models (APMs). The latest projections regarding mandatory quality reporting apply to the estimated 90 percent of participating clinicians expected to fall under MIPS, in which payment changes based on 2017 quality performance can range from 4 percent cuts to 4 percent bonuses.

The excluded clinicians are those who bill Part B less than $30,000 or care for fewer than 100 Part B enrollees annually.

The news regarding the number of affected clinicians underscored the adverse impacts on practices from a CMS delay in notifying clinicians about whether they would be subject to MIPS reporting requirements, said Anders Gilberg, a senior vice president for the Medical Group Management Association (MGMA). Notification originally was due in December.

“It has a significant impact on how practices will implement different [quality] strategies,” Gilberg said. “This is critical information if you are going to perform in [MACRA] in anything above just avoiding the penalty.”

Gilberg said most MGMA practices expected to avoid the MIPS penalties, but lead time is necessary to do well enough to garner bonuses. Practices can use the time to focus investments and project their performance so they can pick the metrics on which they are most likely to succeed.

“Not having this information until May is significant disadvantage because they can’t look across their medical groups and make business decisions related to NPI-PIN combinations [for example], or just whether there are certain specialists that are exempt within their group,” Gilberg said.  

A recent survey of 2,000 physicians found 30 percent were “not at all prepared” for MACRA, while 43 percent were “well aware but need help.” Another 27 percent were “ready to go.”

Gilberg said such findings likely reflect a lack of MACRA knowledge among practicing physicians but not necessarily among staff at larger practices.

“If they are in a medical group, I have some confidence,” Gilberg said. “Solo physicians are going to have a hard time if they are going to really try to do it.”

Meanwhile, health system leaders say they are initiating multiyear efforts to push many of their employed and affiliated physicians into APMs.

More Delays

CMS still has not released other needed MACRA information, such as determinations on whether physicians are viewed as hospital-based or non-hospital-based. That determination is key because hospital-based physicians’ results will be recalculated to exclude MACRA’s electronic health record (EHR) requirements.

Some physicians who work frequently in hospitals but also accept office-based visits could face confusion over whether they are subject to the EHR requirements, Gilberg said.

Another under-released source of vital information for the 2017 performance year is the list of Qualified Clinical Data Registries, which are a reporting mechanism for MACRA quality data.

“The drip, drip, drip isn’t helping physicians and medical groups to make sound financial decisions as well as integrate these new reporting requirements into their own clinical quality improvement programs,” Gilberg said.

Changes Sought

CMS is expected to soon release the proposed rule for the 2018 implementation of MACRA, and some policy watchers are expecting the Trump administration to relax quality-reporting requirements in a manner similar to the approach implemented by the Obama administration for 2017. On March 22, the rule was submitted for review by the Office of Management and Budget, which is the last step before publication.

Facing backlash over expectations that most physicians would face cuts under MACRA, the Obama administration softened MACRA’s first-year quality-reporting requirements by allowing clinicians to avoid penalties for 2017 if they provide 90 days of reporting on just one quality metric.

MGMA plans to push for a similarly reduced reporting burden in 2018, as well as adjustments to MACRA’s cost component and limits on EHR requirements.


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

Publication Date: Monday, May 15, 2017