Medicare Compliance & Reimbursement

Physician advocacy groups cheer Slavitt flexibility.

The deadline for putting into effect the provisos of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is supposed to be Jan. 1, 2017. However, there might be some relief around the corner for those who are uncertain about the possible fallout on their reimbursement.

Background: After reaching out to over “6,000 stakeholders,” the Centers for Medicare & Medicaid Services (CMS) issued a proposed ruling on April 27 concerning a patient-centered, quality-based payment model under MACRA — the Quality Payment Program (QPP), which is expected to go into effect on Jan. 1, 2017.

Two options: The system gives physicians two paths for Medicare payment. One titled the Merit-based Incentive Payment System (MIPS) is the combination of three previously popular CMS programs and simplifies the process of pay-for performance and quality care. The other is a higher-level structure that utilizes advanced Alternative Payment Models (APMs) with tracks dependent on the level of input into the program. Both plans seek to move away from the “one size fits all” style of Medicine so prevalent in today’s healthcare industry.

Fortunately, however, you may not have to make this adjustment as abruptly as originally thought. “We remain open to alternative approaches to achieve these objectives,” Andy Slavitt, CMS acting administrator told the U.S. Senate Committee on Finance in a July 13 hearing dedicated to the outline and initiatives of MACRA. This was the first indication to physicians that CMS may not institute the program on Jan. 1.

Flexibility First

During his question and answer session with Senators, Slavitt maintained that CMS is fully aware of the scope of MACRA and understands and appreciates the worries providers have about the Jan. 1, 2017 start date.

“Some of the things that are on the table we’re considering include alternative start dates, looking at whether shorter periods could be used, and finding other ways for physicians to get experience with the program before the impact of it really hits them,” Slavitt said.

More review on the horizon: The CMS leader promised that his administration would continue to offer education on MACRA and its programs in addition to taking more commentary that would be applied to the final reviews of this comprehensive, quality-based enterprise.

Physician advocacy groups were quick to cheer Slavitt’s potential concessions to their requests for MACRA adjustments. “We are pleased that acting Administrator Slavitt, Secretary Burwell and their colleagues in the Obama Administration are working to give physicians a fair shot at success under MACRA,” said Andrew W. Gurman, MD, president of the American Medical Association (AMA). “We are in complete agreement that CMS’s regulatory framework must focus on patients, increase flexibility, reduce administrative burdens, and concentrate on aspects of health information technology that are critical for delivery system reform and improving patient outcomes.”

Resources: For a look at the testimony of Andy Slavitt, CMS Acting Administrator, visit http://www.finance.senate.gov/imo/media/doc/CMS Testimony - MACRA (A. Slavitt) 7.13.16.pdf.

To watch the recorded U.S. Senate hearing, visit http://www.finance.senate.gov/hearings/medicare-access-and-chip-reauthorization-act-of-2015-ensuring-successful-implementation-of-physician-payment-reforms.