The possibility of a start-date delay to the proposed physician payment system, known as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), has brought about both positive and negative responses among clinicians and other stakeholders within the health care industry
In the recent Senate Finance Committee hearing on the MACRA, Medicare’s Acting Administrator, Andy Slavitt responded favorably to Finance Committee Chairman Senator Orrin Hatch’s proposal for an interim iteration of the final MACRA ruling that is set to be published early November. Slavitt explained that CMS remains open to multiple approaches to allow for additional opportunities for physicians to get the support and experience needed prior to the start of the MACRA. He elaborated his point by saying, “ so it [MACRA] begins on the right foot, so every physician in the country feels that they are set up for success.”
Will a delay really help MACRA get started on the right foot? Many health care industry leaders believe it will. At a recent Alliance for Health Reform meeting, panelists from the American Medical Association (AMA), Trinity Health, and Blue Cross Blue Shield expressed their support for a MACRA implementation delay.
Given the sheer scale of changes required under the MACRA, Thomas Eppes, Jr., MD, AMA Integrated Physician Practice Section Governing Council Chairman, recommends delaying the performance period by six months noting the timeframe for understanding and meeting the MACRA requirements is too short, especially for practices that have a heavy technology lift.
As the proposal stands now, clinicians have a tight window to prepare -- from the time the final guidelines are slated to be published (Fall 2016) to the start of the first reporting year (January 1, 2017). A delay in implementation will provide clinicians with additional time to educate themselves and adapt to the final guidelines with greater success.
Other recommendations provided by those who favor the delay include a soft launch of the program either delaying or staggering the start date for the performance period, a trial period, and/or the ability to phase in certain facets of the program.
Although many in the health care industry support a delay, others are concerned that a delayed start date, no matter the length, will unfairly penalize physicians and physician groups who have been preparing for these changes since 2014. Many of these providers have already made investments with the expectation of a 2019 payment or bonus under MACRA. Additionally, these providers believe the delay is not warranted because the new MACRA programs predominately are comprised of past CMS programs for which they should already have been working towards. These providers also note that the proposed MACRA timeframe is consistent with past CMS practice changes, explaining a similar process occurs each year: proposed program updates and changes in the summer, proposals finalized in the fall, and final rulings implemented the following January 1.
Whether or not there is a delay in the implementation of the MACRA program, we as an industry must be prepared regardless of the final start date. The payment adjustment date of January 1, 2019 remains intact so it is imperative you continue to move forward in your preparation efforts. To do so, we've provided you with resources to help put you on the path to MACRA success!
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