CMS releases final MACRA rule to update Medicare payment

On Friday morning, the Centers for Medicare and Medicaid Services released a final rule for its new payment system established by MACRA, providing greater certainty for physicians on the details of the new system.

“A large number of osteopathic physicians work in small or physician-owned practices, which are the most susceptible to shifts in federal payment,” says AOA President Boyd R. Buser, DO. “We anticipate the new MACRA rule will directly impact about 50% of our members. Announcement of the final rule gives them the certainty needed to plan their approach to the new payment system and the rule addresses many of our physicians’ concerns with the transition.”

MACRA background

Passed in April last year, the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 repealed the Medicare sustainable growth rate formula (SGR), which the Centers for Medicare and Medicaid Services had used as a basis for calculating physician payment. MACRA also established a new Medicare payment system designed to emphasize quality of care.

Under the new payment system, which CMS is referring to as the Quality Payment Program, physicians will choose between using the Merit-Based Incentive Payment System (MIPS), or an approved Alternative Payment Model (APM). MIPS streamlines three existing Medicare quality reporting programs and adds a fourth category for practice improvement. APMs are payment systems that strongly reward quality of care.

CMS is offering physicians significant flexibility on their level of involvement with the new payment system throughout 2017, including how and when they begin reporting.

Final rule

The AOA is disappointed that many physicians who practice in patient-centered medical homes will still not qualify for the APM path, but applauds the final rule’s provisions that will in the future allow small and rural practices to form virtual groups to better position themselves to achieve MIPS bonuses.

“That kind of collaboration could have a ripple effect, where the virtual groups then begin to leverage their numbers and create economies of scale that could help mitigate the costs of information systems and other capital expenditures,” Dr. Buser says. “We look forward to receiving additional details on this aspect of MACRA in the coming year.”

The AOA is also encouraged that physicians have been offered “pick your pace” options for the first year, which will give them time to adjust to the new system, and that CMS has noted that 2018 will have additional accommodations as physicians continue to get used to the new system.

“We are pleased CMS has listened to the concerns of physicians across the country and are hopeful that future transitional adjustments to the program will similarly recognize the full diversity of practice types and needs,” Dr. Buser says.

Every step of the way, AOA has been an integral part of ensuring that MACRA works for osteopathic physicians. So far, among other actions, the AOA has:

• Developed resources for osteopathic physicians to prepare for this significant transition.
• Hosted a MACRA Town Hall at AOA’s House of Delegates for DOs to engage with CMS Acting Administrator Andy Slavitt.
• Held hundreds of meetings with policymakers—both during MACRA’s development and throughout implementation.
• Sent a multistakeholder letter to the Administration promoting the Patient-Centered Medical Home (PCMH).
• Helped shape future Physician-focused Payment Models (PPMs).