Centers for Medicare and Medicaid Acting Administrator Andy Slavitt told the Senate Finance Committee Wednesday that the agency would consider delaying the implementation of MACRA, the industry-overhauling bi-partisan legislation set to go into effect January 1 of next year.
In his testimony before the Committee, Slavitt conceded that small, rural and independent practices will struggle with the new rules, and a central theme emerging from the public comment period was the need to design a program with special consideration for these groups.
"They do not have the resources of larger groups and each new administrative requirement takes time away from patient care," Slavitt said.
He said another central theme from the 4,000 formal comments CMS received asked that CMS look for flexibility to allow physicians, other clinicians and their communities time to learn about and prepare for the sweeping changes.
""While the quality payment program builds on programs that should be familiar to clinicians, we understand new rules require adjustment and preparation," Slavitt said.
As such, he said CMS is "open to multiple approaches", including alternative start dates, shorter reporting periods, and other ways for physicians and clinicians to get experience with the program before "the impact really hits them."
Right now, MACRA is slated for implementation on January 1 2017, with the final rules having been published around November 1, 2016. This means providers would only have 2 months from when the final rules are published until MACRA goes live in which to learn about them and understand how to engage with them.
The law does give CMS flexibility on start of reporting period, Finance Committee Chair Senator Orrin Hatch pointed out.
He also explained that the push is on to find ways to simplify the program and reduce reporting wherever possible so doctors can focus on patient care not paperwork. The use of automatic data feeds so physicians and clinicians don't have to report, as well as eliminating reporting in areas where they historically and consistently do well, and exempting physicians or looking at thresholds for physicians that don't see a lot of medicare patients were measures Slavitt threw out as being on the table.
Ranking Committee member Senator Ron Wyden made it clear a major concern for Medicare and MACRA should be the management of chronic illness, specifically those seniors who struggle with four or more chronic illnesses. He cited statistics illustrating the onus these patients put on Medicare, saying 93 percent of Medicare spending deals with chronic illness and 75 percent deals with seniors who have four or more chronic illness.
Slavitt responded by saying this too is an ongoing focus.
"New approaches to physician payment must emphasize the ability to coordinate care for people who have multiple chronic conditions and to give physicians time to do that and that really needs to be part and parcel of every one of the advanced models that we put forward"
Other bones of contention came from Senators Thune, who voiced disappointment that the "virtual group" rule that would allow smaller practices or solo practitioners to report together won't be worked out for months to come, and also over the proposed low-income threshold which Thune said was far too low at less than or $10,000 total Medicare billing charges and/or 100 or fewer Medicare beneficiaries before a physician doesn't have to participate in MACRA.
Slavitt again said there may be flexibility there, and that they might be open to adjusting those benchmarks.
"The juice has to be worth the squeeze, and if a physician isn't seeing enough medicare patients for this program to be meaningful we shouldn't require them to got through the process," Slavitt said.
In general, Slavitt gave the clear impression that they are still accepting feedback and considering a number of options to further tailor the law to the benefit of providers, and that this process of modification, refinement and improvement will be ongoing for years to come.
"We need to launch this program so that it begins on the right foot and that means that every physician in this country needs to feel like they're set up for success," Slavitt said.
This story was updated on 7/14/16 with additional information from the hearing.