The Centers for Medicare & Medicaid Services’ (CMS) proposed 2018 rule will exempt approximately 834,000 small-practice clinicians from complying with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Under the proposed rule, exemptions would be extended to physician practices with less than $90,000 in Medicare revenue or with fewer than 200 Medicare patients. The original requirements only exempted practices with less than $30,000 in Medicare revenue and fewer than 100 Medicare patients.
MACRA was enacted as a replacement to the Sustainable Growth Rate (SGR) formula that was used to calculate Medicare payment rates to physicians, and that had threatened to cut physician payments for years. Under MACRA’s Quality Payment Program, clinicians have the option of reporting claims through the Merit-Based Incentive Payment System (MIPS) or the Alternative Payment Model (APM).
Compliance with MACRA can be lengthy and difficult, especially for smaller practices who are acclimating to the new quality-reporting system. With these new exemptions and the APM, only 37 percent of 1.5 million Medicare clinicians would be compliant with the MIPS program. However, CMS reports that 65 percent of Medicare payments would still be reported through MACRA methods.
American Medical Association President David O. Barbe, MD, expressed enthusiastic support for this rule, noting that “this flexible approach will give physicians more options to participate in MACRA and takes into consideration the diversity of medical practices throughout the country.”
Sources: Department of Health and Human Services Proposal Draft, June 30, 2017; AMA press release, June 20, 2017.