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How is MACRA Going to Work Out for Physicians?
Thomas M. Anderson, MD
ISMS President
Thomas M. Anderson, MD

Last month, the Centers for Medicare and Medicaid Services (CMS) released the Final Rule for implementing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Many doctors are looking at this new payment system with trepidation. Complying with MACRA will require considerable time and effort. If we look at the big picture, MACRA could be an improvement over Medicare’s previous payment methodology, the flawed sustainable growth rate (SGR) formula.

While MACRA was still in the sausage-making stage, ISMS sent a comment letter to CMS requesting modifications to the proposed rules. I’m happy to report that many modifications in the Final Rule are consistent with our advocacy.

For starters, 2017 will be a “transition year,” meaning that doctors can choose a “test” option and report just one measurement activity. A partial-year reporting option is also part of the Final Rule, which will give physicians more of a chance for a payment uptick.

The Final Rule also ensures that solo practices, small medical groups and physicians working in rural parts of Illinois won’t be at a disadvantage due to practice size or geographic location.

Where the rules fall a little short is the need for a much bigger “carrot” to incentivize physicians to participate in the Advanced Alternative Payment Model (APM), one of the two-payment tracks. Otherwise, most doctors will gravitate toward the other track, the Merit-Based Incentive Payment System (MIPS), which will be more familiar to them. Indeed, CMS expects at least 90 percent of physicians to take this route.

Another area CMS could improve is providing education on how to implement MACRA so that physicians can better understand all the new program rules. MACRA is a historic change in the nation’s Medicare payment system. But where’s the education?

Finally, we have a problem with Physician Compare’s time period for reviewing data. Before MACRA, our Physician Quality Reporting System (PQRS) data was posted on the internet. The time frame we had to review our data was 30 days. But the Final Rule did not budge as far as increasing the review period. Realistically, as we begin to report MIPS data instead of PQRS data, 30 days is no longer a sufficient period of time given the expanded nature of the data that must be reported. ISMS had advocated for a 90-day review period.

It should be noted that the American Medical Association estimates roughly one-third of doctors will be exempt from MACRA reporting and can continue to operate under fee-for-service Medicare without being subject to the MIPS adjustments. Physicians must treat fewer than 100 Medicare patients annually or receive less than $30,000 in reimbursement under the program in order to qualify for the exemption.

Sure, we physicians are very busy caring for patients and are not exactly enamored with having to implement yet another program in the name of “quality.” Yet, even with some of the flaws, it’s possible that living in a MACRA world might not be so onerous after all. But only time will tell.

I look forward to hearing from you. During my term, I can be reached at DrAnderson@isms.org.

Does your practice or group need help demystifying MACRA? ISMS members and their practice management professionals can contact ISMS for hands-on support to help ease the transition. Call your ISMS Advocacy Team at 800-782-4767 ext. 1470 or send an email.

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