Holy MACRA! CMS Proposes New Rule to Exclude 134K Clinicians from MIPS Participation

Holy MACRA! CMS Proposes New Rule to Exclude 134K from MIPS Participation Under MACRA Law

CMS estimated that MACRA compliance will cost the healthcare industry $1.3 billion. To alleviate some of the financial burdens of smaller practices under MACRA law, CMS has proposed changes to Year 2 of the Quality Payment Program (QPP), which includes payment models such as MIPS and APMs.

Released on Tuesday, June 20, the proposed changes will exclude physician practices from MACRA participation and quality reporting that have either less than $90,000 in Medicare revenue or fewer than 200 Medicare patients per year. The current legislation excludes practices with less than $30,000 in Medicare Part B revenue or less than 100 Medicare patients.

This update should come as no surprise, however, considering that the healthcare regulatory giant already excluded nearly 800,000 practices from MIPS participation back in May; CMS believes the new ruling will exclude an additional 134,000 from MIPS participation.

CMS Administrator Seema Verma said in a press release, “We’ve heard the concerns that too many quality programs, technology requirements, and measures get between the doctor and the patient. That’s why we’re taking a hard look at reducing burdens.”

Verma also tweeted:

“The amount of time, effort, and dollars that goes into being MIPS-ready isn’t right” says CODE Technology CEO Breanna Cunningham. “These delays certainly have providers who are not ready or able to meet MIPS requirements jumping for joy as they have more time to prepare.”

“However, it has to be frustrating — for those who have done their homework and spent the time and money investing in the technology needed to participate and succeed in MIPS — that CMS gives those who have not been preparing a pass,” Cunningham says.

What you need to know

Eligible providers can still participate in MACRA and the QPP by taking one of two roads: MIPS or APMs, which you can learn all about in CODE’s latest free offering, A Guide To Orthopedic Payment Models: MIPS, APMs, Bundles and more).

To help illustrate CMS’ flexibility, the proposal keeps “Pick Your Pace” for MIPS, which means practices are allowed more time to learn and adjust to the new program. Pick Your Pace also provides  excluded practices the following participation options in order to avoid a negative payment adjustment down the road:

1. Test Participation. To avoid a negative payment adjustment in 2019, this route requires eligible clinicians (EC) to submit data on either one quality measure, one improvement activity, OR the four required advancing-care information measures.
2. Partial Participation. To avoid a negative payment adjustment in 2019 and possibly earn a small positive one, this route requires data submission for 90 days (instead of a full year) on one of the following:
   1. One or more quality measures;
   2. One or more improvement activities;
   3. More than the four required advancing-care information measures
3. Full Participation. For ECs to earn a positive payment adjustment in 2019 and/or avoid an adjustment into the red, at least 90 days of data is needed for all required quality measures, improvement activities, and the four required advancing-care information measures.
4. Advanced Alternative Payment Models. Exempt from MIPS participation, Advanced APM participants will receive a lump sum equal to 5% of last year’s fee in service payments for their participation.

One very exciting debate in the MACRA conversation is the addition of bonus points for the care of complex patients. A central argument against bundled payments is that this arrangement would negatively impact providers, hospitals, and academic centers that often care for the hardest cases ‚this small bullet point could have a big impact.

Other Highlights Include:

• Practices with 10 or fewer clinicians can participate in a “virtual group” to help with performance reporting by allowing small practices to work together (no matter where they are located) to combine their administrative costs;
• Clinicians can still use 2014-edition certified electronic health record technology, but using the 2015 edition is encouraged as bonus points will be added to scoring for these users which could mean a 10% positive payment adjustment.  American Medical Informatics Association CEO Doug Fridsma, MD, told Healthcare IT news: “The proposal to reward those clinicians who demonstrate a more advanced use of health IT to support patient care through 2015 Edition CEHRT will improve interoperability and provide patients with better access to their data.”
• Bonus points for small practices’ final scores;  
• There will be an option to use facility-based scoring for facility-based clinicians; and
• New hardship exemptions for small practices under the Advancing Care performance category.

As with any CMS proposal, it is soliciting comments, which are due by August 21. You can offer your comments by following the directions outlined on the CMS site.

The American Medical Association (AMA) the most vocal opponent of MACRA implementation, issued the following statement from President David Barbe: “Not all physicians and their practices were ready to make the leap, and many faced daunting challenges. This flexible approach will give physicians more options to participate in MACRA and takes into consideration the diversity of medical practices throughout the country.”

The American Medical Association (AMA) the most vocal opponent of MACRA implementation, issued the following statement from President David Barbe: “Not all physicians and their practices were ready to make the leap, and many faced daunting challenges. This flexible approach will give physicians more options to participate in MACRA and takes into consideration the diversity of medical practices throughout the country.”

Additional Resources

There’s a handful of new literature surrounding this proposal.

• Read the full proposal here (but be warned, it’s 1,058 pages);
• Check out the full CMS Press Release; and
• CMS has published a Fact Sheet on the proposal.