Feds Announce First-Year Break on MACRA Penalties

Responding to strong concerns from the Texas Medical Association and other physician organizations, a top federal official announced Thursday that physicians who at least try to comply with new Medicare payment rules next year will see no penalty in their 2019 payments.

Under the Medicare Access and CHIP Reauthorization Act (MACRA) physicians’ 2017 performance on various quality, cost, technology use, and practice improvement measures will determine cuts or bonuses in their 2019 Medicare payments.

"During 2017, eligible physicians and other clinicians will have multiple options for participation," Andy Slavitt, the acting director of the Centers for Medicare & Medicaid Services (CMS), said in an agency blog post. "Choosing one of these options would ensure you do not receive a negative payment adjustment in 2019."

In response to TMA's request for clarification, CMS spokesperson Aisling McDonough tweeted, "As long as you submit something for 2017, then no penalty. If you submit nothing, then you do get a penalty."

Mr. Slavitt said details for MACRA's first year will come when the agency releases its final MACRA rules by Nov. 1. TMA analysts cautioned that Mr. Slavitt's comments and exactly how they will be implemented are unofficial until the final rules come out.

TMA urges physicians to continue to evaluate their practice's readiness to participate in MACRA and to take steps to comply with the complicated program now if they intend to participate. Among the TMA resources available to help physicians in this process: 

U.S. Rep. Michael Burgess, MD (R-Lewisville), the primary House author of the MACRA bill lauded CMS for listening to "my calls and the calls of the provider community for the flexibility in transitioning to the new payment reporting requirements. … Just as this policy was carefully crafted with the input of everyone affected by the payment policies, the implementation process should be conducted in the same way."

TMA was sharply critical of the massive MACRA rule CMS proposed in April. In a formal comment letter, TMA offered 50 suggestions to improve the draft rule, especially for small practices that the association determined would be hit hard by the costly and complicated compliance requirements. TMA emphasized the need to give physicians more than two months to prepare for what TMA President Don R. Read, MD, called "the largest regulatory program physicians have ever had to comply with under CMS."

"Many of the program requirements, benchmarks, and information to assess reporting options will not be known until the proposed rules are finalized," Dr. Read wrote. "It is not reasonable to expect all physicians to get adequately trained, make the necessary compliance decisions, coordinate with practice management vendors, redesign practice operations and clinical workflows, and train staff all within two months."

Mr. Slavitt on Thursday laid out four MACRA options for physicians for 2017: 

  • In the first option, reporting any data in 2017 will allow physicians to avoid a payment penalty. The goal is to ease providers into broader participation in the following years.
  • The second option allows physicians to submit data for less than a full year. This means their first performance period could begin later than Jan. 1, and that practice could still qualify for a small 2019 payment bonus if it submits data on quality, how it is using technology, and how it is improving.
  • The third option is for practices that are ready to go in 2017 and will submit a full year of data. They could qualify for what Mr. Slavitt called a "modest" bonus in 2019.
  • The final option is to participate in an advanced alternative payment model such as a Medicare shared savings accountable care organization, which could qualify for a 5-percent incentive payment in 2019.

TMA will continue to monitor CMS statements and activities regarding MACRA and will keep members informed of significant developments. To stay abreast of everything MACRA, check in regularly at TMA's online MACRA Resource Center. For a review of all the association has done to affect MACRA policy, see "MACRA: Fix or Folly?" in September’s Texas Medicine.

Action Special Issue, Sept. 9, 2016