Is a Possible MACRA Delay Coming?
As we have repeatedly reported, the proposed MACRA regulation offers what appears to be one of the most significant changes in federal health care policy in years. CMS is expected to announce its final MACRA rule on November 1, 2016, after receiving nearly 4,000 comments on the rule (many of which supported CME). Over the past few weeks, news has been trickling in that MACRA could be delayed. But others are more skeptical.
On July 13, CMS’ Acting Administrator Andy Slavitt told the Senate Finance committee CMS is open to "open to multiple approaches" that might ease the transition into the new rule, which is set to take effect January 1, 2017. The Advisory Board reported that Slavitt stressed his concerns during the hearing that some physicians, particularly at small physician practices, might not be prepared for the MACRA changes set to take effect next year. As a result, he said CMS is considering altering the start date, adding that MACRA's changes need to "begi[n] on the right foot, so every physician in the country feels that they are set up for success." Slavitt also noted the agency may publish an interim final rule this fall to allow for additional feedback, as opposed to a final rue.
Aside from a litany of media reports covering the comments, medical groups quickly pounced, lauding Slavitt’s statement.
"We are pleased that acting Administrator Slavitt, Secretary Burwell and their colleagues in the Obama Administration are working to give physicians a fair shot at success under MACRA," said American Medical Association President Andrew Gurman, MD.
"AMGA appreciates the thoughtful approach CMS is considering in implementing the payment reforms under MACRA," said Donald Fisher, PhD, president and CEO of AMGA, a medical trade association. "Even among the most advanced medical groups and integrated delivery systems, finalizing new regulations in November and beginning a measurement period January is not adequate time for retooling systems."
But … not so fast on the delay
The potential delay discussed during could result in the shortening of the initial performance period. Instead of measuring performance for the entirety of 2017, CMS may elect to measure only the last six months, for example. That would afford physicians extra time to identify relevant measures, focus on performance improvement, and figure out reporting mechanisms. But it would not delay the release of the first round of composite performance scores or the start of payment adjustments January 1, 2019.
Slavitt took this one step further in a fascinating Modern Healthcare interview. It is a very interesting read regarding the development of alternative payment models and MACRA policy. A particular question and answer is one of Slavitt’s only hints about a potential delay.
MH: Is it fairly certain at this point that there will be accommodations for certain types of practices in the final rulemaking as you mentioned in the Senate Finance hearing?
Slavitt: We'll announce that with the final rule. Our goal is to make this successful for our beneficiaries and there is no way to make it successful for our beneficiaries if we don't do it in a way that all physicians feel like they can be successful in that process. I didn't intend to makes news when I said we're going to find a way to get this off to the right start. That's not the same thing as a delay. There are lots of ideas that have come to us and we are considering all of them. (emphasis added)