Support swells for flexibility in implementing MACRA

Concerns about physician readiness permeated a Senate committee meeting chaired by Sen. Orrin Hatch, with CMS suggesting it could be flexible in starting its reform plan.

Indications by a top federal official that the start date for implementing Medicare payment reforms could be changed brought quick support from the nation’s largest physician organization.

In testimony before the Senate Finance Committee yesterday, Andy Slavitt, Acting Administrator for the Centers for Medicare and Medicaid Services, said his agency was concerned about how well physician practices, particularly small settings, would be able to adapt to the breadth of changes included in recent proposed rules.

Slavitt’s written testimony before the panel mentioned the information technology challenges that most practices would face, among other sea changes in reimbursement, before the proposed Jan. 1, 2017, start of the new reimbursement program for physicians.

His comments on Wednesday meshed with those of Senate Finance Committee Chairman Orrin Hatch (R-UT) and and Sen. Ron Wyden (D-OR), ranking member on the panel. Both expressed concerns that small and rural providers wouldn’t be ready, and could be negatively affected, by moving too quickly to the new reimbursement plan.

Slavitt said CMS received nearly 4,000 comments on the proposed rule, which addresses the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the implementation of the Merit-Based Incentive Payment System (MIPS). The program would widely revamp approaches to physician payment to focus incentives on quality, not volume of services.

“Physicians are concerned that they won't have enough time to prepare, and this seems to be a legitimate concern,” Hatch said. “If the final incentive rules are released about November 1, that will give everyone only about two months before this goes live. The MACRA law does give CMS flexibility about the start of physician reporting period. What options is CMS considering to make sure this new program gets off the right foot?”

“We need to launch this program so that it begins on the right foot,” Slavitt replied. “That means that every physician in the country needs to feel like they are set up for success.  So this has been a significant source of feedback that we've received as well.

“We remain open to multiple approaches,” he added. “Some of the things that are on the table that 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.”

Hatch noted that reform of the reimbursement system will be a multi-year process and that “there will be an ongoing need for refinement, and a continuous iterative process. He suggested that an interim final rule, issued in the fall, could be one way to continue the dialogue with stakeholders on the program.

“That option is on the table for us to consider,” Slavitt said. “We know this is a long-term process, and we’re only taking the first step.”

In his testimony before the committee, Slavitt said the MACRA reforms aim to replace a “patchwork of programs,” in which he included the Medicare Electronic Health Record Incentive Program, and modernize Medicare and simplify quality programs as well as payments for physicians.

CMS relied heavily on stakeholder input in crafting the proposed rule and the scoring methodology that will be used to determine physician payments. “In particular, we have been working side-by-side with the physician and consumer communities to address needs and concerns about the Medicare EHR Incentive Program, often known as Meaningful Use for physicians, as we transition it to the Advancing Care Information category in MIPS,” he said. “The new approach heightens focus on the patient, increases flexibility, reduces burden and concentrates on aspects of health information technology, such as health information exchange, that are critical for delivery system reform and improving patient outcomes.”

The dialogue at the committee meeting received quick support from provider organizations representing physicians and physician groups.

A statement from the American Medical Association voiced continued support for continued discussions on a start date for the new reimbursement program.

"We are pleased that acting Administrator Slavitt, Secretary Burwell and their colleagues in the Obama Administration are working to give physicians a fair shot at success under MACRA,” said the statement by Andrew W. Gurman, MD, AMA’s president. “We are in complete agreement that CMS's regulatory framework must focus on patients, increase flexibility, reduce administrative burdens and concentrate on aspects of health information technology that are critical for delivery system reform and improving patient outcomes.

"We were also heartened by Administrator Slavitt's consideration of options that include an alternative start date, shorter reporting periods and finding other ways for physicians to get experience with the program in the early stages of implementation,” Gurman said. “Successful implementation will require flexibility, and indications are that CMS intends to work toward the goal of giving physicians a fair shot in adjusting to this new policy framework."

The AMA, as well as several other organizations, support an alternate start date of July 1 for MACRA implementation, with the goal of allowing sufficient time to prepare physicians and ensure a successful launch of the new system, an AMA spokesman said, adding that the organization is committed to working closely with CMS “to ensure a smooth transition to the new payment system.”

Anders Gilberg, senior vice president of government affairs of the Medical Group Management Association, contends that MACRA gives the country until 2019 to fully adopt the new reimbursement approach, but he acknowledged that “much work lies ahead” before the country’s providers move onto the new system.

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