Lawmakers push CMS for MACRA relief

Senators urged Medicare’s top official to move quickly on rules that would ease federal reporting requirements for small healthcare providers and exempt them from expected payment adjustments.
The Centers for Medicare and Medicaid Services (CMS) is in the process of finalizing rules for a 2015 law — the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA — that establishes a new payment system for doctors that rewards quality instead of quantity.
{mosads}During a Senate Finance hearing Wednesday on the implementation of the law, Sen. John Thune (R-S.D.) told CMS Acting Administrator Andrew Slavitt that he is disappointed the agency is waiting until next year to issue rules on virtual groups, which would allow individual and small practices to combine the reporting required under the reworked payment system.
“It’s going to need a lot more input from physicians to get right,” Slavitt told Thune. “It’s just a whole new way of reporting.” 
Slavitt said the CMS is still discussing with physicians “a number of decisions” that can be answered with more time, “but it’s certainly not something that’s ready to be launched in months.” The CMS expects to have the rules for virtual groups ready in the second year of the program.
The American Academy of Family Physicians, another group urging CMS to make virtual groups available sooner, said without that option, some small practices will not be able to engage in the new payment model when it is implemented next year. 
The group is asking the CMS to create a “safe harbor” to exempt individual and small-group practices until virtual groups are ready.
The CMS is also considering reworking its low-volume threshold exemption, a provision that physician groups say is more important without help from virtual groups. The exemption would allow clinicians or groups with less than $10,000 in annual Medicare charges and less than 100 Medicare patients to be excluded from payment adjustments. 
Thune criticized the exemption for being too low, a complaint echoed by health groups. The American Medical Association (AMA), for example, recommends that the threshold be raised to $30,000 in annual Medicare charges or fewer than 100 Medicare patients. 
The increase would exclude roughly 30 percent of physicians, while the lower threshold that the CMS proposed would exempt around 10 percent of physicians, according to the AMA.
Changing the low-volume threshold is warranted, the AMA said, because several MACRA provisions that were supposed to help small practices have not yet been finalized, such as virtual groups.
“Without this and other key assistance, we urge CMS to expand the low-volume threshold to avoid inadvertently penalizing small practices,” the AMA told CMS in June.

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