Physician Practice

Stakeholders weigh in on MACRA and MIPS

Physician Practice Insider, May 17, 2016

Physician groups and other stakeholders continue to respond to CMS’ release of  the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APM) proposed rule. Some stakeholders released statements offering direct feedback on the proposed rule and outlining how they believe the new payment systems should be structured. Others launched education and outreach efforts to help physicians prepare for the coming change.

The American Hospital Association (AHA) suggested four changes to MIPS it believes will help physicians. MIPS will measure performance across four broad categories, with scores in each category contributing a set percentage to the overall score. The quality category of MIPS will replace the current Physician Quality Reporting System (PQRS) and the quality component of the Value-Based Payment Modifier Program. The AHA believes CMS should ensure that, in the final rule, MIPS measures physicians fairly and encourages providers across the healthcare delivery system to work closely together. The AHA's recommeded changes include:

  • An increased focus on national priority areas in required reporting
  • Risk-adjusted measures that accommodate physicians who care for complex patients
  • Alignment of physician and hospital EHR Incentive Program changes
  • Permitting physicians associated with hospitals to use their hospital’s quality and performance reporting in MIPS

With the implementation of MIPS, CMS has an opportunity to reduce the volume of measures physicians currently report under PQRS and the Value-Based Payment Modifier Program, the AHA said. The more than 200 individual measures physicians must report for 2017 create a heavy administrative burden. In addition, current measures do not always align with national goals or collect data of concrete value. Although CMS has made significant strides toward eliminating redundant reporting in the proposed rule and reduced PQRS reporting measures, the AHA believes the agency should further streamline and coordinate reporting.

The American Academy of Family Physicians (AAFP) rolled out MACRA education and continues to offer comments on MIPS. The AAFP launched a MACRA outreach and education website May 6. The website includes important dates, acronyms, and a review of how value-based payment models affect physicians. The website will be updated regularly, the AAFP says.

The AAFP successfully advocated to have patient-centered medical homes (PCMH) qualify as an APM in the proposed rule. In an April 22 letter, sent only days before the release of the proposed rule, the AAFP urged CMS to class PCMHs as APMs. Although the proposed rule does state that PCMHs qualify as APMs, it’s not clear if they qualify as advanced APMs. PCMHs would need to qualify as advanced APMs to be exempt from MIPS.

The American Medical Association (AMA) expressed support for the proposed rule, saying it believes CMS listened to physicians’ concerns. The AMA also released MACRA and MIPS resources for physicians. The resources currently include tips on preparing for MIPS, key points of the new payment models, and other information on value-based care models.

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