One complaint about MACRA is that it’s too burdensome for small health systems. However, Modern Healthcare suggests that large health system may face similar issues.
In comments to the CMS, large health systems said the agency’s efforts to reduce MACRA burdens on small providers through low-volume exemptions doesn’t lessen the demand on large health systems.
In addition to the concerns about the burden, large systems also spoke out about whether low-volume exemptions will slow the transition for Medicare moving to a value-based system.
The comments come following the CMS’ decision in November to not require practices with less than $90,000 in Medicare Part B revenue or fewer than 200 Medicare Part B patients annually to take part in MACRA’s Merit-based Incentive Payment System (MIPS). The move was an expansion of the previous $30,000/100 exemption and affects 134,000 providers, bringing the number of exempted providers to 934,000.
The CMS expects 39% of clinicians will be eligible for MIPS after the exclusions. However, they will make up 59% of Medicare Part B charges.
It’s not only providers who have raised the alarm about MIPS. The Medicare Payment Advisory Commission (MedPAC) recommended repealing the MIPS payment track. Instead of MIPS, the group, which offers suggestions and guidance to Congress, recommended withholding about 2% of payments for physicians not in an alternative payment model (APM). Providers that join an APM would have the chance to recover the withheld amount.
MedPAC’s proposal to end MIPS was greeted with some pushback, including from the Alliance of Specialty Medicine. Also, the American Hospital Association urged the commission to “use data and experience from the field before advocating for major changes to the MIPS.”