MACRA News: CMS Yields to Pressure with “Pick Your Pace”

Lynn Scheps

Lynn Scheps

VP, Government Affairs & Consulting Services at SRS Health
Lynn Scheps is a leading resource on MACRA, MIPS, and Meaningful Use. She is the SRS liaison with government policy makers. Representing the voice of specialists and other high-performance physicians, she develops strategies to respond effectively to government initiatives.
Lynn Scheps

yieldAs everyone is in the midst of anxiously trying to prepare for MACRA while awaiting the Final Rule, (due November 1), CMS announced yesterday that it is stepping back the requirements and the timetable to make it easier for providers to avoid the 2019 negative payment adjustments set out in the Proposed Rule. This decision comes in the wake of 4,000 comments and subsequent pressure from professional groups and from Congressmen/women pleading for relief from the rushed implementation of a complex and overly aggressive set of requirements that would negatively impact many practices, particularly small groups.

Andy Slavitt, Acting Administrator of CMS, published a blog that gave an overview of the new options that allow providers to “pick their pace” of complying. It appears that the only way a provider would receive a negative adjustment in 2019 would be if they do almost nothing in 2017. He outlined 4 options for participation:

  1. Do something! Avoid a negative payment adjustment in 2019 by submitting some data in 2017. This begs the question: what constitutes “some data?” Does this mean some data in each MIPS category, some data in one category, quality data only? (To me, the wording in Slavitt’s blog is reminiscent of CMS’ past MU shift to “capability enabled” or “met for 1 patient”.)
  2. Report for a short reporting period (“a reduced number of days”) could qualify you for a “small” positive payment adjustment.
  3. Comply with MIPS as defined in the Proposed Rule—or I assume, as it will be defined in the Final Rule— for the full calendar year and you could qualify for a “modest” positive payment adjustment.
  4. Participate in MACRA’s Advanced Alternate Payment Model option. CMS is hinting that it may broaden the definition of an APM.

This news will no doubt be greeted with relief and cheers by most providers, but I wouldn’t be surprised if they are left feeling more uncertain now of what will be required in 2017 than they did before the announcement! What constitutes sufficient reporting in options 1 and 2 above? How many days are in a short reporting period—90 perhaps? How do the revised “small” and “modest” payment adjustments compare to the potential 4% proposed for 2017 and to each other? Will performance still be evaluated relative to other providers? And what happened to budget neutrality, i.e., where is this money coming from if hardly anyone will receive a negative adjustment?

Please let us know what you think of this latest MACRA news, and stay tuned as we learn more!

CMS Offers Welcome Relief for Transition to ICD-10

Lynn Scheps

Lynn Scheps

VP, Government Affairs & Consulting Services at SRS Health
Lynn Scheps is a leading resource on MACRA, MIPS, and Meaningful Use. She is the SRS liaison with government policy makers. Representing the voice of specialists and other high-performance physicians, she develops strategies to respond effectively to government initiatives.
Lynn Scheps

reliefIt’s time for those still advocating a delay of ICD-10 to abandon the fight—but they can take heart in the recent concessions offered by CMS. The AMA, concerned about the complexity of ICD-10, has asked for some measure of protection from potential adverse financial impacts of the transition to the new code set, and CMS recently agreed to a one-year compromise.

Recognizing the challenges for providers, CMS has agreed:

  • Not to deny claims based on the (lack of, or incorrect) specificity of the ICD-10 code, as long as the reported code is a valid code from the right family of codes.
  • Not to subject providers to penalties under 2015 quality reporting programs, (Meaningful Use, PQRS, or the Value-Based Payment Modifier), as long as a valid code from the right family is reported for the measure(s).
  • To create an ICD-10 Ombudsman to help negotiate solutions to ICD-10 related problems.

CMS has also acknowledged realistic challenges on its side, and is insulating providers from resulting financial harm by agreeing:

  • To authorize advance payments if Medicare contractors are unable to process claims in a timely fashion (as defined by CMS) due to problems with ICD-10.
  • Not to penalize providers under MU, PQRS, or the V-BPM if CMS “experiences difficulty calculating the quality scores.”

You can read about the above in CMS’ own words in its FAQ document.

Notwithstanding the above, it’s time to get serious about preparing for the transition to ICD-10, if you have not already begun that process. Fortunately, there are some ICD-10 solutions embedded in EHRs and PM systems that make code selection easier than others, but regardless of the particular system you employ, there is a learning curve for physicians, clinical teams, and billing staff members.