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6 Key Takeaways from MACRA Final Rule

  1. Flexibilities provided in the first transition year may continue in 2018.
  2. During the first year of MIPS, providers will not be evaluated on cost or resource use.
  3. Despite flexibilities allowed under the final rule, it is in providers’ best interest to participate as much as possible during the transition year — and not just for the practice.
  4. Quality measure benchmarks will be published this year.
  5. Vendors need to prepare, too.
  6. Small group providers and solo physicians could get squeezed out.

Source: Becker’s Hospital Review


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6 Responses

  1. Docs’ Threats to Leave Medicare Could Cause GOP to Slow MACRA Rollout

    Physicians have pledged to retire or leave Medicare as a result of burdens placed on them by the recently finalized payment rule. That could spur Republicans, now fully in charge of the government, to slow federal value-based payment efforts. But the Medicare Access and CHIP Reauthorization Act, or MACRA, was a bipartisan policy change, making it unclear if the GOP would want to dial back a law that has received wide approval.

    Despite finalizing the rule, the CMS left it open for comment, and complaints are pouring in from providers who say they are at wit’s end. With the nation already facing a physician shortage, it is likely Congress will take these comments seriously, said Kristen Valdes, a former vice president at UnitedHealthcare who founded b.well, a Baltimore-based digital health start-up. Congress may choose to slow implementation of MACRA until they can assess how many physicians would leave Medicare or the profession because of the law, she said.

    Source: Virgil Dickson, Modern Healthcare via PMNews [11/10/16]


  2. MACRA

    If Trump intends to decrease regulations which harm businesses, how will this affect MACRA?



  3. CMS Launches Online Tool to Ease MACRA Compliance

    The CMS just released an online tool meant to help clinicians find which new Medicare payment models best suit them and their practices. The tool is an application program interface or API that will allow physicians and their practices to build software that enables sharing of quality measure data for MACRA.


    The application has been used by “tens of thousands” of users so far, according to the CMS. It’s one of many ways the agency is trying to ease concerns by providers who are feeling the pressure of impending deadlines. Reporting of quality data begins in January. Payment on that data will come two years later.

    Source: Maria Castellucci, Modern Healthcare [11/17/16] via PMNews


  4. CMS Releases API to Help Providers Understand, Choose MACRA Measures

    MACRA, is coming soon, and with it CMS’s Quality Payment Program, which requires providers who bill Medicare more than $30,000 a year to report certain performance measures in order to adjust their payments based on performance. For providers who don’t have time to slog through the 2,400 page final rule, figuring out what those measures are and how to report them is a challenge. So last week, CMS released an API aimed at addressing that uncertainty.

    CMS itself created the first app based on the API, called Explore Measures. It allows users to “select measures that likely fit their practice, assemble them into a group, and print or save them for reference,” according to CMS. In addition, Able Health has built a tool using the API called the Able Health MIPS Measures Knowledge Base, which is designed to make the information about quality measures more accessible and searchable.

    Source: Jonah Comstock, Mobile Health News [11/21/16] via PMNews


  5. MACRA: It’s a trick!

    “IT could be most difficult part of the shift to MACRA – A Stoltenberg Consulting survey released in March found that two-thirds of responding healthcare providers and health information professionals are unprepared for the MACRA program, which aims to improve coordination of care and outcomes while cutting costs through value-based reimbursement.”

    By Joseph Goedert, April 11 2017.


    If you thought Meaningful Use requirements were swell, you will just love MACRA.

    D. Kellus Pruitt DDS

    EDITOR’S NOTE: MU and PQRS are no longer stand-alone initiatives but have been rolled into MACRA.


  6. CMS Gives 800,000 Docs a Pass on MACRA Requirement

    More than 800,000 clinicians will not have to comply with Merit-based Incentive Payment System reporting requirements outlined in MACRA, which may save them millions collectively in compliance costs. The majority of physician practices were expected to use the Merit-based Incentive Payment System, known as MIPS, to comply with MACRA as opposed to alternative pay models. Under MIPS, payments would be based on a compilation of quality measures and use of electronic health records.

    The CMS has now sent letters to 806,879 clinicians saying that they will not be evaluated under MIPS in 2017. Up to 642,000 physicians were slated to submit MIPS data, but that number has now dropped to 418,849. The exempted physicians include those with less than $30,000 in Medicare charges and fewer than 100 unique Medicare patients per year are exempt from complying with MIPS. Clinicians new to Medicare this year are also exempt this year.

    Source: Virgil Dickson, Modern Healthcare [5/11/17]


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