5 Things to Know About the MACRA Final Rule

HHS has issued its final rule on the Medicare Access and CHIP Reauthorization Act (MACRA), which reforms the Medicare payment system as part of the shift to value-based care. Here are 5 things to know about the final rule.

This morning, HHS announced that it had finalized its rule on the Medicare Access and CHIP Reauthorization Act, or MACRA, which will implement a Quality Payment Program to reward providers for high-quality care. Here are 5 things to know about the highly anticipated final rule:

1. MACRA replaces the sustainable growth rate (SGR) formula

The SGR was a method for CMS to control spending by Medicare on physicians services. Every year on March 1, the fee schedule was supposed to update and reduce physician fees if spending exceeded a target based on overall economic growth. However, the flawed formula resulted in yearly cuts that Congress voted every year for 13 years to temporarily delay until the next year. As a result, physicians were facing a 21% cut in Medicare physician fees in 2015.

MACRA was created to replace the SGR and focus on rewarding high-performing providers and promoting value-based payment models.

2. It was shaped by reactions to the April proposal

CMS released a 962-page proposal for the 2015 law’s implementation in April of this year, sparking discussion among physicians, patients, and other stakeholders. The final policy, which clocks in at 2398 pages, takes into account feedback gathered during the comment period, which featured a listening tour attended by almost 100,000 people. The nearly 4000 comments had some common themes, emphasizing flexibility, simplicity, and support for small practices.

Although this is the final rule, HHS emphasized that it is not shutting the door to feedback. Today’s announcement is another step in an ongoing collaborative process, during which HHS will continue to host listening and learning sessions. Feedback and comments from physicians, patients, and other stakeholders will be welcomed during the 60-day comment period.

3. Confusion is anticipated, but resources are available

Prior to the release of the rule or even the proposal, CMS acknowledged that all of the “components together can be very confusing for clinicians as they learn more about the program,” said Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS, during an interview with the American Journal of Managed Care.

In anticipation of these difficulties, the final rule includes a number of support initiatives to help smooth the adjustment process. Along with its new Quality Payment Program educational website and robust outreach efforts, MACRA will provide $20 million a year over the next 5 years to offer “free, on-the-ground, specialized help” to small practices. The timeline also designates 2017 as a transition year so providers can gain experience with the rule at their own pace.

4. Clinicians can pick between 2 pathways

The Quality Payment Program offers 2 options for providers to choose from based on what makes sense for their practice. The first is the Merit-based Incentive Payment System (MIPS), which would reward clinicians who submit performance data showing they provide quality care. The second, the Advanced Alternative Payment Model (APM) track, goes further by offering payment incentives for clinicians participating in an innovative payment model, such as an accountable care organization (ACO).

5. Flexibility is key, especially for APMs

One common concern voiced by doctors after the proposal was that the standards for qualifying as an Alternative APM were too difficult to achieve. In response, the final rule provides more flexibility by offering new opportunities like the ACO Track 1+ model, as well as allowing more existing models to qualify as Advanced APMs. Because CMS has eased the proposed risk criteria for Advanced APMs, a broader range of future models could be included in this category, like those tailored to small practices or specialties.