CMS Launches Final MACRA Rule
Written by Editor   
Saturday, November 05, 2016 11:00 PM

The Centers for Medicare & Medicaid Services released the long awaited final MACRA rule on physician payment.  Compared with a previous draft rule issued last April, it eases the reporting burden for clinicians and triples the "low-volume" threshold dollar amount for mandating participation, to practices that bill more than $30,000 in a year or care for more than 100 patients. CMS also announced an interactive website and additional resources and training for small and rural practices.

The overarching concept of payment reform under MACRA is to shift healthcare away from paying for volume to paying for value — improving care and outcomes through efficient and smart use of resources -- through a Quality Payment Program (QPP).

Over the last several months, CMS conducted a listening tour to solicit feedback regarding the MACRA rule. They received nearly 4,000 comment letters regarding and almost 100,000 attendees participated in outreach sessions.  Slavitt synthesized those conversations and letters in a single directive: “Make the transition to MACRA as simple and as flexible as possible."

He explained that CMS responded to this feedback by allowing physicians to choose how quickly they advance into the program through a “pick your pace” format, offering options so that physicians can customize the program to their own specialty and practice.  Slavitt noted that the agency had also cut the number of metrics required for reporting in half.  And announced the launch of a new “one-stop shop portal" at

Slavitt also spoke of a new option in 2018 called "ACO Track One," which is an accountable care organization specifically designed to appeal to small practices, because it involves lower levels of risk and still allow participation in the so-called Advanced Alternative Payment Models -- one of the two tracks included in the QPP, that ultimately yields an annual 5% bonus for participants.

In 2018, Slavitt said he expects about 25% of eligible clinicians to participate in the advanced APMS.  In 2017, he estimated, the agency will pay approximately $1 billion in bonuses for high quality care to clinicians in both QPP channels, on top of the 0.5% positive payment adjustment.

The second track, the MIPS, combines elements of a handful of prior reporting schemes -- the Physician Quality Reporting System, the Value-based Payment Modifier, "Meaningful Use" or the Medicare Electronic Health Record (HER) Incentive Program for Eligible Professionals -- into one unified program that consists of four performance areas:

  • Quality

  • Resource use

  • Clinical practice improvement

  • Advanced Care Information

The three prior reporting program will terminate at the end of 2018 with the MIPS programs and policies rolling out in 2019, when MIPS physicians will receive a positive negative or neutral adjustment based on their scores across these four categories in prior years.

For reporting purposes, the initial reporting period was slated to begin in January 2017 for all participating clinicians but in response to many clinician groups who felt the window too narrow between the final rule and the reporting, CMS announced a "pick your pace" format, intended to allay some of those fears.

It will be offering four options allowing physicans to dip their toes in the MACRA waters — submit only a portion of their data in 2017 or for only a portion of the year and avoiding a penalty -- or taking the full plunge -- participating for the full calendar year beginning in January 2017.

CMS fleshed out the details of the four data submission options under the MIPS framework on the call:

  • No data and receive a negative 4% payment adjustment

  • Minimal data in 2017 -- e.g., one quality measure -- and avoid a negative payment adjustment

  • 90 days of 2017 data -- earn a neutral or "small positive payment adjustment"

  • Full years's worth of 2017 data -- possibly earn a "moderate positive payment adjustment"

Data must be submitted by March 31, 2018. The first payment adjustments will take effect on Jan. 1, 2019.