CMS finalizes low-volume exemptions in MACRA final rule
- The CMS finalized exemptions from MACRA’s reporting requirements, according to a final rule released Thursday, which also states providers who choose the Merit-based Incentive Payment System (MIPS) track will be evaluated in part on their cost cutting measures during the second performance year.
- Also Thursday, CMS released its physician fee schedule final rule, which estimates a 0.41% increase in payment rates next year compared to 2017. A separate final rule for outpatient payments reduces the rate for procedures at hospital-owned off campus outpatient facilities, but by less than the CMS originally proposed.
- Other provisions in the MACRA rule include a Medicare Advantage alternative payment model, the allowance of physicians to use their hospital’s value-based care data for MIPS quality and cost requirements. As in the proposed rule, clinicians can continue to use the 2014 edition of certified EHRs for MIPS.
The CMS has had a busy week of final rulemaking. On Wednesday, the agency released final regulations that include a major cut for drug payments to hospitals that use the 340B Drug Pricing Program. The long-anticipated Quality Payment Program final rule — which implements MACRA — and three other rules updating physicians payments leave providers with quite a bit of reading material for the weekend.
The American Hospital Association (AHA) said it was pleased with CMS’ “flexible approach to the MACRA’s physician quality payment program” but was not happy with the reduction in payments for off-campus outpatient facilities. The decision to reduce the payments from 50% of regular outpatient rates to 40%, instead of the 25% the CMS was considering, did not appear to assuage AHA’s concerns. “We are particularly concerned about the impact on rural and vulnerable communities that do not have sufficient access,” AHA EVP Tom Nickels said in a statement.
There were more concerns from invested organizations. “MGMA is very disappointed that CMS quadrupled the length of the quality reporting period under MIPS from the current 90 days to 365 days in 2018," Anders Gilberg, SVP of Government Affairs at MGMA stated. "This fourfold increase to the quality reporting requirements is in stark contrast the agency’s statements today that the final rule reduces regulatory burdens. CMS is in effect prioritizing quantity over quality and giving physicians less than 60 days to prepare for the 2018 MIPS requirements.”
The exemption for small providers leaves the CMS expecting about 934,000 providers in total will be exempt from MIPS next year. The agency said it was heeding concerns from practices with little cash on hand that said overhauling their EHRs to comply with the law would be cost-prohibitive and difficult to do in the time available. Now, providers with less than $90,000 in Medicare Part B charges or fewer than 200 Part B beneficiaries will be exempt from MIPS.
The CMS expects 39% of clinicians will be eligible for MIPS after the exclusions, but they will make up 59% of Medicare Part B charges.
A big change from the proposed rule is a change in the weighted MIPS category. The provision to evaluate 10% of MIPS payments through cost cutting in the second performance year is meant to help ease into the 30% requirement set to be enacted in the third performance year. The CMS had considered waiving that part of the rule for the second year in a row but walked that back with the final rule. In addition, weighted score in the quality category were finalized at 50%, down from 60%.
CMS finalized the allowance of clinicians forming virtual groups to participate in MIPS. The rule defines a virtual group as a combination of a solo practitioners or a group with 10 or fewer eligible clinicians banding together with at least one other solo practitioner or group for a performance period of a year. Virtual groups are largely seen as a means for smaller practices or solo clinicians to dip their toes into taking on more risk to advance their move to value-based care.
While CMS has recently walked back bundled payment programs, the inclusion of virtual groups and the fact that a majority of Part B charges will be evaluated under MIPS is encouraging for value-based care champions.
One important change in the physician fee schedule: new telehealth services were added. CMS will now reimburse telehealth services regarding health risk assessments, care planning for chronic care management, psychotherapy for crises and interactive complexity. This is a win for providers as they seek to modernize their practices and engage in telehealth services.
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