Could MACRA Be Delayed?

During a recent Senate Finance Committee hearing, CMS Acting Administrator Andy Slavitt hinted at the possibility the agency might delay the start date of the Medicare Access and CHIP Reauthorization Act, or MACRA. Under MACRA, CMS would begin measuring performance in 2017 for payments that begin in 2019 – a timeline that has been a huge concern for physicians that are still awaiting a final rule.

“Every physician in the country needs to feel like they are set up for success,” and to do that the agency “remain[s] open to alternative approaches,” which include later start dates, shorter reporting periods and additional methods to ease physicians into the program,” Slavitt said during the hearing.

With no official start date confirmed for MACRA, and a final rule expected to be published Nov. 1, physicians are on edge about the timing of this new program, which is set to replace the sustainable growth rate formula for physician payment adjustments under Medicare. The Medical Association joined the American Medical Association and numerous physician groups to urge CMS delay implementation of MACRA, and ensure new federal reimbursement programs “reward physicians for the improvements they make to their practice and the quality of care they provide to their patients.”

In his testimony, Slavitt conceded that small, rural and independent practices will struggle with the new rules, and a central theme emerging from the public comment period was the need to design a program with special consideration for these groups.

“They do not have the resources of larger groups and each new administrative requirement takes time away from patient care,” Slavitt said.

He said another central theme from the 4,000 formal comments CMS received asked that CMS look for flexibility to allow physicians, other clinicians and their communities time to learn about and prepare for the sweeping changes.

“While the quality payment program builds on programs that should be familiar to clinicians, we understand new rules require adjustment and preparation,” Slavitt said.

Slavitt said CMS would consider numerous approaches to help delay and soften the blow of MACRA going live, including alternative start dates and shortened reporting periods. CMS is also looking into ways to reduce reporting burdens and eliminate reporting where physicians have consistently performed well.

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