MACRA final rule is here: 9 reactions, afterthoughts & takeaways

CMS dropped a landmark final rule Friday morning for the Medicare Access and CHIP Reauthorization Act, which determines physician Medicare payment fees after the repeal of the sustainable growth rate formula.

Here is how nine industry leaders reacted to the major reform.

1. Andrew Gurman, MD, president of the American Medical Association responded positively to the news. "Our initial review indicates that CMS has been responsive to many of the concerns raised by the AMA, and in the days ahead, the AMA will conduct a comprehensive review of the final rule to ensure that it promotes flexibility and innovation in the delivery of care to help meet the unique needs of all patients," Dr. Gurman said in an emailed statement.

2. Medical Group Management Association President and CEO Halee Fischer-Wright, MD, echoed AMA's statement, but with some disappointment about the lack of flexibility beyond the first year. "MGMA is pleased with the significant burden reduction for physician practices in the first year of the MIPS program and new alternative payment model options outlined in the final rule," Dr. Fisher-Wright said in an emailed statement. "It's disappointing that flexibility provided for quality reporting in 2017 largely disappears in 2018 and beyond. CMS missed an opportunity to close the two-year gap between the measurement and payment periods, which would facilitate improved patient care by providing actionable feedback to physicians and more timely incentives. The sheer magnitude of a 2,400-page regulation and its impact on physician practices can't be ignored."

3. Tom Nickels, executive vice president of government relations and public policy at the American Hospital Association, felt the final rule presented both challenges and opportunities for hospitals and their employed or contracted physicians. "While we are disappointed that CMS continues to narrowly define Advanced Alternative Payment Models, which means that less than 10 percent of clinicians will be rewarded for their care transformation efforts, we are encouraged that CMS is exploring a new option that would expand the available advanced APMs that qualify for incentives," Mr. Nickels said. The AHA was pleased CMS increased the flexibility in the rollout of the program, but remains concerned that the program does not properly adjust for patients' socioeconomic backgrounds. "[T]he AHA remains concerned that the lack of sociodemographic adjustment to the measures used in the MIPS will unfairly disadvantage clinicians and hospitals caring for the poorest patients," Mr. Nickels said in the statement.

4. Boyd Buser, DO, president of the American Osteopathic Association, praised the opportunity for small and rural practices to form virtual groups and report Merit-Based Incentive Payment System data together. "That kind of collaboration could have a ripple effect, where the virtual groups then begin to leverage their numbers and create economies of scale that could help mitigate the costs of information systems and other capital expenditures," Dr. Buser said in an emailed statement.

5. Tom Lee, PhD, founder and CEO of SA Ignite, an IT company that develops value-based care support platforms. "This is generally positive for providers. It shows CMS is listening," Dr. Lee told Becker's Hospital Review. "They struck a pretty good balance of keeping providers accountable for improving performance, and allowing those who are ready to get on the treadmill and start running fast to earn rewards in the first year."

Mr. Lee and his team have already highlighted a host of ways CMS has made the law more palatable to provides, including the option to report on just one measure in the MIPS to avoid a penalty, reducing the number of clinical practice improvement activities required, raising the patient threshold so small providers are exempt in the first year and using historical data to set quality measure benchmarks before Jan. 1.

6. Farzad Mostashari, MD, former HHS National Coordinator for Health IT and CEO and co-founder of Aledade, said in an emailed statement the MACRA final rule helped direct the country toward healthcare transformation. "The rule will move the country to where doctors are reimbursed for quality and value not volume. In creating a clear path for small, independent physicians to embrace the transition to value, CMS makes it possible for leading independent practices to reduce costs, boost outcomes and thrive. The creation of viable pathways for these practices is critical to maintaining competition and personalized care in our communities. There is still work to be done to help these practices come together in virtual groups, and to stand on equal footing with larger, more integrated groups. We hope the next Congress and Administration takes up and quickly acts on this issue in the new year," Dr. Mostashari added.

7. Blair Childs, senior vice president of public affairs for Premier, a healthcare solutions firm, said in a statement the members of Premier's hospital and provider alliance support the potential of MACRA's Quality Payment Program, as well as CMS' move to make the Advanced Alternative Payment Model pathway more accessible, but they feel improvements could still be made.

"Although CMS eased the policy defining the Advanced APM to allow additional programs to qualify and has signaled it will increase the number of available models, the nominal risk standard remains way too high. … We call on CMS to rethink this risk standard in future rules to incent greater participation. We also call on CMS to accelerate recognition of 'virtual' physician groups that would allow small practices to band together using technology to meet the minimum thresholds and comply with reporting requirements," Mr. Childs said.

8. Donald Fisher, PhD, president and CEO of AMGA, said in a statement his organization appreciates the work that went into the final rule and the level of engagement with providers throughout the process. "We remain concerned, however, that in its understandable desire to provide flexibility, particularly as the program begins, CMS does not adequately recognize or reward the providers and systems who have made the investments to improve quality and decrease costs. We believe rewarding performance should be based on the value provided, not on size of the practice," Dr. Fisher said.

9. L. Patrick James, MD, chief clinical officer of health plans and policy and medical affairs at Quest Diagnostics, noted the emphasis the final rule placed on technology. "The final rule places heavy importance on the use of technology, so it's clear that healthcare data and analytics will play an increasingly important role in MACRA adoption. Physicians want to focus on their patients and delivering great care, and technology can help them do that provided it aligns with their concerns as healthcare practitioners," Dr. James said in an emailed statement.


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