Practice Economics

CMS: MACRA impact on small/solo practices not as dramatic as predicted in regs

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Take time to understand MACRA

Dr. Michael E. Nelson, FCCP, comments: If you are unfamiliar with MACRA, or alternatively don’t feel concerned about it, you will very likely notice a reduction in your income over the next few years. As a punishment for advocating the demise of the Sustainable Growth Rate formula (SGR), the Federal Government has come up with the Quality Payment Program (QPP), which includes the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APM). The Physician Quality Reporting System (PQRS), Value-Based Payment Modifier (VM) and Medicare Electronic Health Record (EHR Meaningful Use) are being morphed into the Merit-based Incentive Payment System (MIPS). If you don’t like this, you may choose an Alternative Payment Model (APM). You may use either of these as an Eligible Professional (EP). These programs are being phased in between 2015 and 2021. If all of these eponyms have looked like gibberish to you, I would encourage you to go to the CMS website, Google, Facebook, or whatever information source you use and self-educate.



MACRA will not be as hard on small and solo practices as it first appeared when draft implementing regulations were published, according to Andy Slavitt, administrator of the Centers for Medicare & Medicaid Services.

Mr. Slavitt testified May 11 before the House Ways & Means Health Subcommittee to address legislators’ concerns about how the government intends to implement the Medicare Access and CHIP Reauthorization Act of 2015.

Andy Slavitt

Andy Slavitt

Rep. Sam Johnson (R-Tex.) expressed concern that the draft regulations published April 27 project “the greatest negative impact on payments to practices with nine or fewer doctors and the least harm to large systems with 100 or more docs.”

The calculations in the draft regulation were based on data from 2014, a year in which few small and solo practices reported quality data.

“In 2015 and subsequent years, the reporting went up,” Mr. Slavitt testified. “So at best, this table would be very, very conservative. ... Reporting is going to be far easier going forward.”

Mr. Slavitt said that the CMS will do all it can to help ensure that small and solo practices have every opportunity to participate in the both the Merit-Based Incentive Payment System (MIPS) and in advanced alternative payment models.

“The question of making sure that small groups and solo practitioners can be successful is of utmost importance. Our data show that physicians who are in small and solo practices ... do just as well as physicians that are in practices that are larger than that,” he said, adding that technical assistance specific to solo and small practices is being developed to help them transition to these value-based payment models.

Other federal officials have been spreading the same message to physicians. Speaking May 7 at the annual meeting of the American College of Physicians, Dr. Thomas A. Mason, chief medical officer in the Office of the National Coordinator for Health Information Technology, pointed out that the MACRA legislation put aside $20 million a year for 5 years beginning in 2016 to help solo and small practices transition to MIPS and APMs.

“It is specifically to help with the shift and transforming practices to measuring quality and improving quality performance,” he said in an interview. “The MACRA statute specifically calls out what the dollars need to be used for and the two points are for assisting MIPS-eligible professionals and improving their MIPS composite score as well as the transition to advanced alternative payment models.”

The U.S. Department of Health & Human Services already has begun soliciting contractors to support small and solo practices, he added.

“Direct technical assistance through this program will target eligible clinicians in individual or small group practices of 15 or fewer, focusing on those practicing in historically under resourced areas,” according to a request for proposals. “Technical assistance is defined as provider outreach and education, practice readiness, practice facilitation, health information technology (HIT) optimization, practice workflow redesign, change management, strategic planning, assisting clinicians in fully transitioning to Alternative Payment Models, and enabling partnerships.”

The federal health IT office plans to provide more information on the availability of transition assistance soon, Dr. Mason said.

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