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What is MACRA, Really?

The healthcare industry has less than six months to prepare for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). But according to a recent survey by Deloitte, it may be an uphill battle.


According to Deloitte’s 2016 Survey of US Physicians, “half of surveyed physicians have never heard of MACRA, and most physicians would have to change aspects of their practice to meet the law’s requirements and do well under its incentives.” (MACRA: The status quo is not an option,” Deloitte Perspectives, Health Care Current, July 19, 2016)


The report’s authors wrote that there seems to be a variety of misconceptions among physicians about MACRA. For example, some see it as “the law that repealed the sustainable growth rate (SGR),” leading them to believe that they can move on and forget about the recurring annual doc fix debate.


When CMS announced last week that it is open to considering changes to the implementation of MACRA, the report authors speculated that physicians may see this as a repeat of ICD-10 implementation – a deadline that will inevitably change before it is finalized.


“But, MACRA is more than a Medicare payment law or a fix to the SGR debate. And it is here to stay.” (MACRA: The status quo is not an option,” Deloitte Perspectives, Health Care Current, July 19, 2016)


MACRA is intended to be a transformative law to fundamentally change how physicians and other clinicians are reimbursed under the Medicare Physician Fee Schedule. It will also drive major healthcare payment and delivery system reform for clinicians, health systems, Medicare, and other government and commercial payers for years into the future. (See iProtean, now part of Veralon blog/newsletter, “Comments to CMS: MACRA Threatens Viability of Smaller ACOs,” June 22, 2016)


When MACRA goes live in 2019, it promises bonuses for top-performing doctors and clinicians and penalties for underperformers on a variety of measures, especially quality of care. Some of the key points include: (“Blog: Holy MACRA! Half of docs have never heard of Medicare payment reform,” Modern Healthcare Daily Dose, July 14, 2016)


  • Two payment tracks: clinicians in advanced alternative payment models can earn bonuses annually of 5%. Clinicians in the Merit-based Incentive Payment System can earn plus or minus 4 percent of reimbursement in 2019, 5 Percent in 2020, 7 percent in 2021 and 9 percent in 2022.


  • MACRA projections from CMS: the vast majority of physicians in groups of less than 10 will suffer penalties—87 percent of solo practitioners, 70 percent of physicians in groups of two to nine.


For physicians in groups of 25 to 99, 55 percent can expect reimbursement to increase, as will 81 percent of physicians in groups of more than 100 .


Even though physicians are aware of coming financial pressures, many are generally unaware of the impact of MACRA. Many physicians will have a lot of work to do over the next few months to prepare for January 1, 2017. (MACRA: The status quo is not an option,” Deloitte Perspectives, Health Care Current, July 19, 2016)


To read the Deloitte survey, click here.


CMS Announcement of Implementation Delay


Amid a “crush” of concerned feedback from providers, Medicare is considering delaying the January 2017 start of data collection under MACRA according to Andy Slavitt, the agency’s leader. The proposed rules would require most physicians paid under Medicare to begin tracking various quality indicators on January 1, 2017. (“CMS Considering Delaying MACRA: Slavitt,” HFMA Weekly News, July 15, 2016)


CMS is open to multiple approaches, according to Slavitt. It is considering alternative start dates, shorter periods, eliminating all reporting for some physicians, dropping reporting requirements for physicians who are already performing well and finding other ways for physicians to get experience with the program.


Nearly 4,000 comments have been submitted to CMS, and 64,000 attendees have participated in more than 200 MACRA discussion sessions through CMS. Many of the comments highlighted concerns that small and independent practices would have a hard time meeting MACRA’s new quality-reporting requirements. Physicians who fail to meet quality-reporting thresholds under one of the two MACRA tracks—which is expected to include most physicians—will face cuts of up to 9 percent of their total Medicare payments in future years. (“CMS Considering Delaying MACRA: Slavitt,” HFMA Weekly News, July 15, 2016)



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