Final MACRA Rule Includes Real Improvements

In the wake of this summer's withering criticism of the Centers for Medicare & Medicaid Services' (CMS) draft rule to implement Medicare's new quality payment programs, CMS Acting Administrator Andy Slavitt pledged that he and his staff would listen to physicians' real concerns about the Medicare Access and CHIP Reauthorization Act (MACRA). It looks like that listening included TMA's formal comments on the rule and the hundreds of letters Texas physicians sent.

CMS published the final rule on Oct. 14, and, at first blush, the 2,398-page document appears to include some significant improvements for physicians and patients. TMA suggested many of those improvements in the 50 recommendations we submitted to CMS in our formal comment letter on the draft rule.

TMA staff experts will continue to analyze the final rule in depth. Per their preliminary findings, the final rule includes:

  • A small increase in the low-volume threshold, exempting any physician who sees fewer than 100 Medicare patients or submits Medicare charges of less than $30,000. (The draft rule set that amount at just $10,000.) CMS estimates that the low-volume threshold alone will exempt 28 percent of family practitioners and 25 percent of general surgeons.
  • A one-time, first-year reduction in the composite performance threshold so that any physician who earns a score of 3 out of a possible 100 points will not receive any Medicare payment penalties. (Remember, data collected on 2017 performance will affect physicians' 2019 payments.) Any physician who successfully reports one quality measure or one of the new improvement activities will earn 3 or more points, and thus be protected from the possibility of a 4-percent cut in 2019. This is how CMS met the unofficial promise Mr. Slavitt made last month that physicians who at least try to comply with the rule next year will see no penalty in their 2019 payments. Because of this decision, CMS estimates that about 95 percent of eligible physicians will get a positive or neutral payment adjustment in 2019. This low standard applies only to the 2017 reporting year; the performance requirements will increase in 2018 and beyond.
  • A system that allows physicians and groups the flexibility to determine the most meaningful quality measures and reporting mechanisms for their practice and their patients. TMA asked CMS to "keep it simple." In the interests of simplicity, we will just report here that they did.
  • An option for physicians to report information on their use of health information technology for just 90 days in 2017. This is the old meaningful use program. The draft rule would have required a full calendar-year reporting period beginning in 2017. Physicians can choose to report full-year metrics, and that will increase their chances of obtaining a larger bonus.

TMA will continue to work with CMS and the Texas congressional delegation to rewrite and reform many of the problems identified in the draft regulations.

"I am pleased to see significant alterations and increased flexibility built in that reflect changes called for by the medical community," U.S. Rep. Michael Burgess, MD (R-Lewisville), the primary House author of the MACRA legislation, said of the final rule. "In particular, it is evident that the regulation is responsive to the needs and concerns presented by small, independent, and rural practices. I appreciate that CMS and Administrator Slavitt have taken every possible step to maximize and incorporate the input from clinicians."

TMA Can Help

Physician practices across the country will have a busy two-and-one-half months trying to get ready to begin collecting and reporting data on Jan. 1. Practices still face a host of decisions about what path they will take to try to comply with the biggest change in Medicare payment policies in more than a generation. TMA has developed a host of tools, education, and services to help:

To keep up with all the latest, visit TMA's online MACRA Resource Center regularly.

Action - Oct. 17, 2016

Last Updated On

April 19, 2018