The Centers for Medicare and Medicaid Services proposed changes to the MACRA rule for 2018 this week, and medical groups have reacted mostly favorably, praising the agency for suggesting payment rule changes that would allow more flexibility for small, independent and rural practices particularly.
Under the new rule, clinicians will benefit from an increased low-volume threshold that exempts eligible MIPS clinicians with less than $90,000 in allowed charges, or less than 200 Part B beneficiaries, from having to participate in the program. That ups the threshold of $30,000 in allowed charges or 100 beneficiaries found in the 2017 rule.
American Medical Association President David O. Barbe, MD, said in a statement that the new flexibility benefits both patients and physicians and provides better incentives for improvement.
"Not all physicians and their practices were ready to make the leap, and many faced daunting challenges," he said. "This flexible approach will give physicians more options to participate in MACRA and takes into consideration the diversity of medical practices throughout the country."
Tom Nickels, executive vice president of the American Hospital Association, also praised the changes, saying in a statement that the AHA is "encouraged by CMS' proposal for a facility-based clinician reporting option that may promote better alignment and collaboration on efforts to improve quality among hospitals and clinicians."
Nickels also applauded the proposal to provide relief from "unfunded mandates" for electronic health record capabilities by extending the modified stage 2 meaningful use requirements through 2018. He encouraged CMS to extend the same relief to hospitals.
The American Medical Group Association was more measured in its praise. While generally in favor of the changes, the group said it remains concerned that the proposed rule delays the switch to value-based reimbursement, saying the program needs to be "fully implemented" and "fully incentivize high performers in the Medicare program."
When it came to clinicians' contracts with Medicare Advantage plans, AMGA said, "Even though CMS expects all current Advanced Alternative Payment Model participants to meet the thresholds for Advanced APM qualifications, revising the regulations to allow additional providers to be considered will encourage participation in such value-focused models."
AMGA pointed out that more than 31 percent of Medicare beneficiaries are enrolled in a Medicare Advantage plan, with that number steadily increasing. By providing another pathway to participation, the group said, CMS would include more patients and providers in Advanced APMs.