When the Medicare Access and CHIP Reauthorization Act (MACRA) was enacted into law, Congress
intended for the Medicare program to evolve from
simply paying for the volume and intensity of services
provided to rewarding value, or performance relative to
spending. Medicare providers would be held accountable not only for the quality of care, but for spending
or spending growth.
CMS has an opportunity to revise its
proposal and endorse AMGA’s recom-
mendation to fully implement MACRA
as Congress intended.
In the Centers for Medicare & Medicaid Services’
(CMS’) recently proposed 2018 MACRA rule, CMS
unfortunately backed away from transitioning Medicare from fee-for-service to value-based payment, and
instead proposed to ostensibly maintain the status quo.
CMS does have an opportunity to revise its proposal
and endorse AMGA’s recommendation to fully implement MACRA as Congress intended.
Impeding the MIPS Program
For its initial year of MACRA, or what CMS terms
the Quality Payment Program (QPP), CMS opted to
create a transition period that allowed for minimal
participation in the Merit-Based Incentive Payment
System (MIPS) program. Dubbed “pick-your-pace,”
this allowed eligible clinicians to participate in MIPS at
a minimal level. Specifically, eligible clinicians can meet
MIPS requirements and avoid a Part B reimbursement
decrease by, for example, reporting on a single quality
measure for a single Medicare beneficiary.
In the first year of MIPS, which is currently under-way, an eligible clinician needs to achieve no more than
a Composite Performance Score (CPS)—the score that
determines the payment adjustment under MIPS—of
three points to avoid a negative payment adjustment
in 2019. AMGA opposed this action, even though we
understood CMS’ intention to provide a transition
period. In its proposed rule for 2018, the second year
of the MIPS program, CMS is ending the pick-your-pace option, but is poised to continue excluding about
two-thirds of otherwise eligible clinicians by increasing
the low-volume thresholds. This year, CMS excluded
about 700,000 clinicians from MIPS. Next year, CMS
is proposing to exclude more than 900,000.