CMS offers alternatives for MACRA implementation

Shedding some light on its initiative to promote value-based healthcare, the U.S. Centers for Medicare and Medicaid Services (CMS) has announced that it will offer physicians four options for implementing provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

The move comes in response to protest from physician groups and members of Congress that the agency's timeline for implementing the Quality Payment Program mandated by MACRA isn't realistic. CMS announced in April that the program would be finalized in November and would go into effect on January 1, 2017 -- and practices that aren't making progress could be in for reimbursement cuts.

At a Senate Finance Committee hearing on July 13, Acting Administrator Andy Slavitt said that CMS was aware of concerns about the planned timeline for MACRA and would consider 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 Sen. Orrin Hatch (R-UT), the committee chair.

To this end, CMS is now offering four participation alternatives, he wrote in a September 8 blog post.

"In recognition of the wide diversity of physician practices, we intend for the Quality Payment Program to allow physicians to pick their pace of participation for the first performance period that begins January 1, 2017," Slavitt wrote. "During 2017, eligible physicians and other clinicians will have multiple options for participation. Choosing one of these options would ensure you do not receive a negative payment adjustment in 2019."

The four options are as follows:

  • Test the quality payment program. "With this option, as long as you submit some data to the Quality Payment Program, including data from after January 1, 2017, you will avoid a negative payment adjustment. This first option is designed to ensure that your system is working and that you are prepared for broader participation in 2018 and 2019 as you learn more," Slavitt wrote.

  • Participate for part of the calendar year. "You may choose to submit Quality Payment Program information for a reduced number of days. This means your first performance period could begin later than January 1, 2017, and your practice could still qualify for a small positive payment adjustment," Slavitt said.

  • Participate for the full calendar year. "For practices that are ready to go on January 1, 2017, you may choose to submit Quality Payment Program information for a full calendar year," Slavitt wrote. "This means your first performance period would begin on January 1, 2017."

  • Participate in an Advanced Alternative Payment Model (AAPM) in 2017. "Instead of reporting quality data and other information, the law allows you to participate in the Quality Payment Program by joining an Advanced Alternative Payment Model," Slavitt wrote. "If you receive enough of your Medicare payments or see enough of your Medicare patients through the Advanced Alternative Payment Model in 2017, then you would qualify for a 5% incentive payment in 2019."

These alternatives will be described fully in CMS' November 1 final rule, according to Slavitt.

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