MACRA 911: Physicians Urge MACRA Delay

The Medical Association joined the American Medical Association and numerous physician groups to urge the Centers for Medicare & Medicaid Services delay implementation of the Medicare Access & CHIP Reauthorization Act of 2015, which replaced the Medicare Sustainable Growth Rate, 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.”

MACRA has been sharply criticized by physicians because of its framework establishing payment incentives for physicians and other clinicians based on quality of care rather than quantity, or fee for service. This framework for determining care standards, or Quality Measure Development Plan, includes measures in six quality “domains” such as clinical care, safety, care coordination, patient and caregiver experience, population health and prevention, and affordable care. Physicians would be paid based on their quality and cost metrics.

CMS plans to base reimbursements in 2019 on physician performance beginning Jan. 1, 2017. The proposed start date is too early and will create significant problems for the launch of the MACRA programs, and physician groups are calling for a six-month delay.

Other recommendations include:

  • Provide more flexibility for solo physicians and small group practices, including raising the low-volume threshold
  • Provide physicians with more timely and actionable feedback in a more usable and clear format
  • Align the different components of MIPS (Merit-Based Incentive Payment System) into a unified program rather than four separate parts
  • Simplify reporting burdens and improve odds of success by creating more opportunities for partial credit and fewer required measures within MIPS
  • Reduce reporting thresholds for quality measures

According to a new Medscape Medical News survey, almost four in 10 physicians in solo and small group practices predict an exodus from Medicare within their ranks on account of the program’s new payment plan and its punishing penalties. Fifty-nine percent of physicians in practices with fewer than 25 clinicians also said they expect to receive a performance penalty as high as 4 percent under proposed regulations that implement MACRA. Only 9 percent of physicians in under-25 groups expect a bonus, with another 12 percent counting on no change in compensation. Roughly one-third of physicians in small practices said merger into larger groups promises to be the most likely fallout from MACRA.

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