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To delay MACRA or not is the question

Eight high-ranking congressmen are calling on federal healthcare officials to consider “flexibilities” in administering the new MACRA healthcare law, particularly as it applies to small physician practices.

However, in a Sept. 6 letter to Sylvia Burwell, secretary of the Department of Health and Human Services, the congressmen, who include members of both parties, did not go as far as calling for a delay in the Medicare Access and CHIP Reauthorization Act.

Interestingly, it was Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid, Services (CMS), who – during a July Senate Finance Committee hearing – raised the prospect of delaying the Jan. 1, 2017 official start date of MACRA’s first quality reporting year.

As it stands now, physicians (though not hospitals, because MACRA does not apply to hospitals), would record and report quality measures under MACRA’s MIPS (merit-based payment system) program. Reimbursement and penalties under the new system are now scheduled to start to be applied in 2018.

In Slavitt’s public remarks, he did not specify how long a delay might be, but just suggested “alternative start dates,” shorter reporting periods and other help for physicians.

In the meantime, groups representing doctors and payers have pressed for a delay and easier reporting requirements, arguing that as is MACRA would be onerous for many doctors and physician practices.

In their letter, the congressmen asked CMS officials to consider “flexibilities” including:

  • Simplified requirements
  • “Clear pathways” to succeed in MIPS or alternative payment model (APM) tracks
  • Opportunities for doctors to move to APM tracks and more flexible ways to be reimbursed for “meaningful delivery system reform activities” in MIPS and APMs.

Nonetheless, the congressmen, who include two powerful committee chairmen, two ranking committee members and four subcommittee chairmen, affirmed their support for MACRA, which Congress overwhelmingly passed last year.

“While MACRA requires significant changes in physician payment to move to value over volume, we believe that many of our nation’s physicians are ready for these changes as they incorporate the physician payment and quality predecessor programs which have been in existence for many years,” the letter said.