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FEDERAL | CMS Releases the MACRA Final Rule

The Centers for Medicare and Medicaid Services (CMS) released its long awaited final rule last week outlining how the agency would implement the Medicare Access and CHIP Reauthorization Act (MACRA), legislation that repealed the sustainable growth rate (SGR) physician payment formula and replaced it with a system designed to base reimbursement on the quality of care provided to patients.

CMS received more than 4,000 comments on the proposed rule, and more than 100,000 stakeholders participated in sessions with CMS to provide feedback on the draft. In response to concerns about the administrative burden of the payment overhaul on providers, CMS built in some additional flexibility to the rule. The final rule made MACRA more flexible in a number of ways including: 1) making 2017 a transitional year; 2) increasing the low volume threshold; and 3) reducing the number of clinical practice improvement activities (CPIAs) physicians will have to complete. The flexibilities in the final rule were applauded by many lawmakers, including Energy and Commerce Committee Chairman Fred Upton (R-MI), Ranking Member Frank Pallone, Jr. (D-NJ), House Ways and Means Committee Chairman Kevin Brady (R-TX), and Ranking Member Sander Levin (D-MI). "We're pleased to see the administration responded to many of our concerns and followed our recommendation to provide clinicians and practitioners more flexibility in the issuance of the final rule for MACRA," the lawmakers said. "These steps help enhance practitioner participation in new Medicare payment opportunities that will ultimately improve patient care and outcomes." The additional flexibility built into the rule will make complying with the program easier for ASPS members:

1. Year One is Now Transitional
In September, CMS teased changes to MACRA that would make 2017 a transitional year, rather than requiring full participation from the onset. (It's important to note that the 2017 performance year will impact 2019 Medicare payments.) The final rule details new flexibility for practitioners to pick their pace of participation, and the most important takeaway is this – the only physicians who will receive a payment penalty in 2019 are those who do not report any performance data next year. Additionally, participants will be eligible to receive a payment bonus once they have exceeded 90 days of performance reporting.

2. More ASPS Members Will Now Be Exempt
MACRA allows for physicians who do a "low volume" of Medicare business to be exempt from its reporting requirements. CMS initially proposed to set the threshold for that low volume exception at $10,000 in allowable charges under Part B and fewer than 100 Medicare patients seen. The final rule increases the exception to $30,000 or fewer than 100 patients, a huge step in the right direction for many ASPS members.

3. Fewer CPIAs are Needed to Receive Full Credit
While much of MACRA is essentially a consolidation and continuation of the existing Physician Quality Reporting System (PQRS), Value-based Payment Modifier, and Electronic Health Record "Meaningful Use" programs, it also introduces a new domain on which physicians will be scored – Clinical Practice Improvement Activities (CPIAs). In the final rule, CMS lowered the number of these activities that practitioners will have to conduct in order to receive full credit. Previously, full CPIA participation would only have been satisfied by completing six medium-weighted or three high-weighted activities. That has been lowered to four medium-weighted or two high-weighted activities. If you are in a small practice (15 or fewer participating providers), this requirement is lowered even further, to one high-weighted or two medium-weighted activities.

ASPS is conducting a deep analysis of the final rule. Look for a summary of key provisions for plastic surgeons in the December Issue of Plastic Surgery News, and look for additional communications about educational resources and tools to help you participate in MACRA that ASPS is developing. In the meantime, CMS has launched a new website to provide additional education and resources related to the QPP.

CMS.gov, What's the Merit-based Incentive Payment System (MIPS)?