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Dr Katherine Schneider on the Disappointments and Realities of MACRA Final Rule

The Delaware Valley Accountable Care Organization (ACO) was disappointed to learn that under CMS’ Medicare Access and CHIP Reauthorization Act (MACRA) final rule, the practice would not be categorized as an advanced alternative payment model (APM) and would likely have less of an upside under the Merit-based Incentive Payment System (MIPS), said Katherine Schneider, MD, president of the Delaware Valley ACO. However, Dr Schneider said she understands CMS’ point of view and why it needed to make changes to the final rule.


The Delaware Valley Accountable Care Organization (ACO) was disappointed to learn that under CMS’ Medicare Access and CHIP Reauthorization Act (MACRA) final rule, the practice would not be categorized as an advanced alternative payment model (APM) and would likely have less of an upside under the Merit-based Incentive Payment System (MIPS), said Katherine Schneider, MD, president of the Delaware Valley ACO. However, Dr Schneider said she understands CMS’ point of view and why it needed to make changes to the final rule.

Transcript (slightly modified)

What about the MACRA final rule did you find disappointing?

When we were looking at the math, basically, of the new incentives that are coming into play, and the penalties as well, obviously we were disappointed that Track 1 ACOs were not categorized as Advanced APMs that would be eligible for that track of getting the 5% bonus, because we’ve done a lot of that groundwork and we are not in a downside risk model, which is probably another story. But when we began to look at MIPS, which was designed to be budget-neutral so it’s a graded on a curve, losers pay the winners kind of model, that in fact for those of us who have been preparing, we felt that the chances of our coming in pretty high on that curve and having some substantial upside in the MIPS program, they were pretty high.

And so, now I understand CMS’ point of view completely, that holistically they need to do this in a fashion that is not disruptive in an extremely negative manner. So with 2017 being more of a transition year, they’ve made it easier to avoid penalties, and also easier to achieve some of the upside. So what that means in a more budget-neutral model is that those who are very high performers just have less opportunity during the transition year, if that makes sense. Selfishly, we probably have less of an upside under MIPS than we had before the new rules came out. 

 
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