Could MACRA implementation be delayed?

2014 02 26 18 14 31 705 Capitol Hill 200

The U.S. Centers for Medicare and Medicaid Services (CMS) is mulling over various options for implementing the Medicare Access and CHIP Reauthorization Act (MACRA), including potentially pushing back the start date of January 1, 2017, according to acting CMS administrator Andy Slavitt.

Speaking at a Senate Finance Committee hearing on July 13, Slavitt said that CMS is aware of concerns about the planned timeline for MACRA and is considering alternative approaches for implementation.

"We want to make sure that the program launches on the right foot and that every physician in the country feels like they're set up for success," he told committee members, including committee chair Sen. Orrin Hatch (R-UT).

CMS plans to release its final rule on new payment models under MACRA in November, with the rule going into effect January 1, 2017. Hatch expressed concern, however, that this schedule won't allow physicians enough time to comply, and he noted that the law gives CMS flexibility to move back the reporting date start period.

"Physicians are concerned that they won't have enough time to prepare to effectively participate in the new MACRA incentive program when it starts on January 1," he said. "Assuming that CMS releases the final incentive rule around November 1, physicians would only have about two months before it goes live. It's a legitimate concern. ... What options are CMS considering to ensure the program starts on the right foot?"

Slavitt stated that CMS is open to "multiple approaches," including alternative start dates, assessing whether shorter reporting periods could be used, and finding other ways for physicians to get help and experience with the new program before its impact hits.

"We're open to alternative approaches to achieve MACRA's objectives," he said.

Hatch noted that ongoing refinement of the law's implementation will be needed, and he inquired about CMS' plans for continued program improvements, suggesting that perhaps the agency could release an interim final rule before November.

"That option, as well as others, are on the table," Slavitt said. "We know that this is a long-term process, and we're only taking the first step. CMS needs to shorten the window between the practice of medicine and policy implementation."

Finally, Hatch asked Slavitt to comment on ways physicians' reporting burden could be reduced.

"Physicians really have two tasks they do every day: They're either seeing patients or doing paperwork," Slavitt said. "The less time they need to focus on the latter, the more time they'll have [for patient care]. We're open to lots of ideas, such as figuring out how to reduce the need for reporting at all. We have some categories where we can get automatic data feeds from physicians and don't need to ask them to report, and there are other areas where we know physicians are performing well and we don't need to have them report. We're also looking at areas where we can exempt physicians or [establish] thresholds for those who don't see a lot of Medicare patients."

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