Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

House Reps Ask CMS for MACRA Implementation Flexibilities

CMS should consider MACRA implementation flexibilities to ensure all eligible clinicians have the chance to succeed under new reimbursement structures, lawmakers say.

By Jacqueline Belliveau

- Representatives from the House Ways and Means Committee and the House Energy and Commerce Committee have penned a letter to HHS Secretary Sylvia Mathews Burwell calling for more flexibilities with MACRA implementation.

House representatives call on CMS to explore MACRA implementation flexibilities

With the value-based care law scheduled to start on January 1, 2017, the House leaders asked CMS to consider how MACRA implementation will affect eligible clinicians, especially those in small practices, and implored the agency to take measures to guarantee that all participants are ready for reimbursement changes before the law goes into effect.

“With these principles, we urge the Center for Medicare and Medicaid Services (CMS) to ensure that all physicians and practitioners have an equal opportunity to succeed under the Quality Payment Program,” the letter stated.

Lawmakers explained that CMS should contemplate several flexibilities, including simplified and streamlined requirements, explicit pathways to succeed in both the Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Model (APM) tracks, and the implementation of appropriate systems for reporting in January 2017.

In terms of reimbursement, the representatives also want CMS to consider more options for participating in the APM track and more opportunities for eligible clinicians to earn value-based incentive payments for “meaningful delivery system reform activities” under both reimbursement tracks of the Quality Payment Program.

Without more time to adjust to the enhanced requirements, some providers may not be able manage the transition to the Quality Payment Program, making MACRA just as burdensome as previous value-based care programs.

While the House committees fell short of asking CMS to postpone the launch date of MACRA, noting that some clinicians are actually ready to make the switch, many other healthcare industry groups have already voiced their support for a delay.

In its comments on the proposed MACRA implementation rule, the American Medical Association (AMA) advised CMS to delay the start date until July 1, 2017. The first year would act as a transitional period designed to help eligible clinicians move away from prior Medicare reporting requirements, learn about MACRA’s reimbursement tracks, and establish workflows and system changes suited to the new system.

A later go-live date would also allow health IT vendors to update their products to meet MACRA requirements and give CMS more time to add existing alternative payment models to the Advanced APM track, the organization stated.

The American College of Rheumatology (ACR) also called for postponing MACRA’s implementation date, citing lack of time to prepare for the new reimbursement programs. The specialist group also suggested that CMS reduce the 2017 reporting period.

“We are concerned that the proposed timeline will impede rheumatologists’ ability to prepare and comply with the extensive new requirements,” wrote ACR President Joan M. Von Feldt, MD, MSEd.

“[W]e request that in implementing this delay in the timing for the first performance year, for any measures where a change in the denominator volume or duration of reporting period could unduly influence performance on the measure, some provision(s) in the reporting or performance requirements be made,” Von Feldt added.

Providers may also benefit from either more MACRA flexibilities or a delayed start date in order to learn more about the value-based reimbursement program. According to a July survey from the Deliotte Center for Health Solutions, half of non-pediatric physicians reported that they had never heard of MACRA, and only 32 percent of the 600 physicians surveyed recognized the name of the legislation.

“The changes associated with MACRA are fast approaching,” said Anne Phelps, Principal and US Healthcare Regulatory Leader at Deloitte and Touche LLP. “The fact that so many physicians and clinicians still haven't heard of the law means they'll have a lot of work to do over the next five months, including evaluating current payment processes and understanding how physicians are organized within their hospitals or practices.”

Dig Deeper:

What We Know About Value-Based Care Under MACRA, MIPS, APMs

Why Flawed Alternative Payment Model Design Holds MACRA Back

Continue to site...