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“Pick Your Pace” for MACRA Rollout (But Don’t Be Too Slow)

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CMS Acting Administrator Andy Slavitt recently announced that CMS would provide new physician reporting options for the first year of the MACRA program starting January 1, 2017. In response to concerns about the MACRA Proposed Rule, including how excessive reporting can distract from patient care, Administrator Slavitt outlined four options for first-year reporting, which are summarized below.

As we noted in a recent Health Law Checkup blog post, it is perhaps not surprising that CMS chose to provide physicians with additional flexibility for the program’s first-year reporting requirements, given the condensed rollout schedule.  Ultimately, we still need to see the final details in the MACRA Final Rule, which is due out by November 1, 2016, to gauge how much flexibility CMS is actually providing and whether there are any intended or unintended consequences for physicians that pick a “slower” reporting pace.  For example, payment adjustments for those participating in the Merit-based Incentive Payment System (“MIPS”) will increase dramatically – from plus/minus 4% in 2019 to plus/minus 9% in 2022 – so physicians may not want to slow down efforts to prepare for MACRA, despite these new first-year reporting changes.

First Option – Report “Some” Data.  With this option, physicians that report “some data” to the MACRA Quality Payment Program, including data from after January 1, 2017, can avoid a “negative payment adjustment,” which presumably means no positive payment adjustment either. This option is designed to test the physician’s reporting systems as physicians gear up for broader participation in 2018 and 2019.  It is not clear how much data is considered “some data” to qualify for this option. We expect the MACRA Final Rule to clarify this option’s requirements.

Second Option – Partial Participation.  Under this second option, physicians can submit data for a reduced number of days starting January 1, 2017.  CMS intends for this option to allow physicians to report data for part of the year for a “small positive payment adjustment.”  We will need to wait for the MACRA Final Rule to confirm what percentage of the full year reporting requirements will be required and what amount constitutes a “small positive” payment adjustment.

Third Option – MIPS.  This third option seems to merely re-state the MACRA Proposed Rule’s requirements for physician to report data through MIPS starting January 1, 2017.  Administrator Slavitt noted in his blog post, perhaps somewhat optimistically: “We’ve seen physician practices of all sizes successfully submit a full year’s quality data, and expect many will be ready to do so.”

Fourth Option – Advanced APM.  Finally, this fourth option seems to merely re-state the MACRA Proposed Rule’s option that allows physicians participating in an Advanced Alternative Payment Model (“Advanced APM”) to avoid data reporting and still receive a five percent incentive payment beginning in 2019. We will be looking to the MACRA Final Rule to see whether CMS agrees to broaden its definition of an Advanced APM to include more value-based payment models, including those with reduced downside financial risk.

Keep checking back to the Health Law Checkup for MACRA developments and analysis of CMS’ MACRA Final Rule.