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MONDAY Rx – Happy Halloween!

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After speaking with several members following the issuance of the final rules relative to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), sentiments can be summed up with nerve wracking, skeptical optimism. Some are sharing that they are “less stressed” now that federal officials have responded to physician concerns, but many solo and small primary and family practice LACMA members realize that future years of the Quality Payment program could prove challenging for eligible Medicare physicians.

Following the release of the nearly 2,400 page rule on Oct. 14, I’ve listened and shared the latest on what is specifically happening and more importantly, changes between the proposed and final rule and the rationales that the Centers for Medicare & Medicaid Services (CMS) offered for its decisions.

Relatively Good News…
The relatively good news is that many of these adjustments were responses to physician feedback that resulted in the government reducing burdens, helping physicians “ease into” the new program, lower risk thresholds for what qualifies as advanced alternative payment models (APMs), and provide more flexibilities so smaller physician practices don’t get penalized for not having the tools or resources to thrive under MACRA.

For the most part, CMS seemed to listen very closely to physician concerns, as the agency continues to collect feedback in the 60-day window before the first reporting period kicks in on Jan. 1, 2017.

The Final Rule
The Advisory Board released a statement applauding the relief that the Final Rule afforded in the first year. “Most—if not all—clinicians should be able to avoid a negative payment adjustment for performance year 2017. CMS proposes three options for providers subject to MIPS [Merit-Based Incentive Payment System] in 2017, the easiest of which providers can meet by reporting a single metric. CMS has also raised the low-volume threshold, exempting more small practices from MIPS,” the statement read.

Modifications in Reporting
CMS announced flexibilities that will allow eligible Medicare physicians to pick their pace of participation for the first performance period of the program that begins Jan. 1, 2017, aiming to allow physicians to ease into the program if they choose without getting hit with negative payment adjustments right away. These pathways range from sending in only some data to the Quality Payment Program; to sending in more data but for a reduced period of time; to “going all in” for an advanced APM.

Confirmed via the Final Rule, in 2017, only those physicians on the MIPS track who don’t send in any data will receive a negative 4 percent payment adjustment; all others will receive a neutral or positive payment adjustment. The negative/neutral/positive payment adjustments in MIPS will grow to 9 percent by 2022. To this end, The Advisory Board also expressed satisfaction that providers will not be scored on the “resource use” category in 2017 and can satisfy full-year reporting requirements by reporting for a 90-day period.

As LACMA/CMA members, you have an abundance of resources at your fingertips. Here’s a quick break down…

You can visit the CMA website for the quintessential latest on MACRA. And they just posted stories on MACRA today in a newsletter.

I’ve included the MACRA Executive Summary for your review.

The AMA has a MACRA test you can run for your practice. Try it here (but note that the AMA will be making changes as they dive further into the 10/14 CMS update.)

I would highly encourage all LACMA members facing MACRA realities attend the November 9th event hosted by the Asian American Pacific Islander Physician Advisory Committee titled, “CMS Priorities and MACRA.” Dr. Ashby Wolfe, Chief Medical Officer at the Centers for Medicare and Medicaid Services will be speaking.
Click here for more details.

Hear from your colleagues on MACRA at our web site.

You can also visit our YouTube channel and hear from Dr. C Freeman, Dr. Emil Avanes, Dr. Lemmon McMillan and Dr. Stephanie Booth on MACRA.

And finally…I’d like to hear from you. Is the MACRA Final Rule Trick? Or Treat?

3 Quick Event Updates
November 3 – LA Healthcare Awards. Tickets still on sale.
November 4 – Young Physician’s Networking Mixer. Details here.
November 5 – Addressing Physician Burnout & Physician Wellness Conference.

Please join us!
Look to social media and the blog this week for updates on our survey about healthcare and the presidential election. We’ve had some surprising results! Stay tuned…

Thank you,

Gustavo Friederichsen
Chief Executive Officer
Los Angeles County Medical Association
“If it matters to our LACMA members, it matters to me.”

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