Highly Anticipated MACRA Rule At OMB; In Final Stage Of Review

Highly Anticipated MACRA Rule At OMB; In Final Stage Of Review

September 21, 2016 | InsideHealthPolicy | John Wilkerson

CMS on Wednesday (Sept. 14) sent the final rule for the highly anticipated MACRA physician pay system to the White House Office of Management and Budget for review. Although the Medicare Access and CHIP Reauthorization Act is separate from the Affordable Care Act, the success of much of ACA's delivery and payment reforms, including accountable care organizations, depend on CMS' ability to implement a new physician pay system that gets physicians to become more efficient.

Many lobbyists and consultants thought it would take CMS longer to send the rule to OMB. Agency officials have said they expect to publish the regulation by early fall, and no one knows whether OMB will review it faster than that.

The agency has been struggling to get the balance right on the new pay system. It wants to get physicians to accept the risk of penalties for poor performance while not alienating them with standards that penalize many doctors without much hope of receiving bonuses.

"MACRA has the potential to shape the delivery system of the future by incenting creation of the advanced risk bearing organizations that will provide care to future generations of medicare beneficiaries," CAPG Vice President of Federal Affairs Mara McDermott said. "To fulfill that potential, CMS has to ensure that there are appropriate incentives for risk-bearing physician groups."

MACRA creates a two-part pay system in which providers either qualify as alternative payment models or they are subject to Merit-based Incentive Payment System. Physicians must start reporting to the Quality Payment Program next January, and payment will be adjusted in later years based on that performance.

As part of the balancing act, Acting CMS Administrator Andy Slavitt last week said CMS will give physicians longer to prepare for the new pay system. Physicians may avoid pay cuts in the first year by merely reporting information next year, and they have other options for participating in MIPS with less risk.

Most physician groups praised Slavitt for going easy, but some physicians who prepared for the new system are bothered that they will now get smaller bonuses in the first year.

CMS is implementing MACRA at a critical time. After years of slow growth, health care spending appears to be speeding back up. The Obama administration is relying on accountable care organizations to curb Medicare spending growth, but so far results have been mediocre; the most recent CMS figures show that Medicare spent $217 million more in bonuses to accountable care organizations than the ACO program saved. And ACOs don't include drug spending, which is growing faster than other segments of Medicare, according to the Campaign for Sustainable Rx Prices. --