(Story updated at 5:50 p.m. ET)
CMS Acting Administrator Andy Slavitt told lawmakers Wednesday that the agency is considering delaying the start date for Medicare payment reform, which is set to go into effect Jan 1.
Testifying before the Senate Finance Committee, Slavitt said the CMS is concerned that some physicians, particularly at small practices, may not be ready for the changes under the Medicare Access and CHIP Reauthorization Act that replaced the much-maligned sustainable growth-rate formula.
Several medical groups, including the American Medical Association, the American Academy of Family Physicians and the Medical Group Management Association, have encouraged the CMS to delay MACRA.
In his opening testimony, Slavitt said the CMS is open to alternative measures that will achieve the agency's objectives, which include patient participation and reducing reporting burdens for practices.
Senators continued to show great concern for small and rural practices, which have said MACRA could force them to join hospitals or larger practices because of the paperwork and payment changes required.
Slavitt said the CMS is aware of these potential conflicts and also concerned. The CMS has received "significant feedback", Slavitt said. "Some of the things that are on the table, (that) we're considering include alternative start dates, looking at whether shorter periods could be used, and finding other ways for physicians to get experience with the program before the impact of it really hits them."
“The focus on small independent practices and their ability to continue practicing independently is a very important priority for us,” he said.
Dr. Wanda Filer, president of the American Academy of Family Physicians said her organization has requested a MACRA start date of no earlier than July of next year and would prefer January 2018.
A lot of AAFP members are small groups of providers that are still trying to understand the rule and what it means for them. There are a lot of questions as well as some confusion and anxiety, she said.
But she has been pleased with how the CMS and Slavitt have reached out to answer those questions and provide help.
“I think we're cautiously optimistic that there's going to be some flexibility going forward,” she said.
American Medical Association President Dr. Andrew Gurman said in a statement he was “heartened” by CMS considering options such as alternative start dates and shorter reporting periods.
“Successful implementation will require flexibility, and indications are that CMS intends to work toward the goal of giving physicians a fair shot in adjusting to this new policy framework,” he said.
Slavitt also said methods of gathering data other than provider reports could help doctors focus on patient care. Some information could be gathered from automatic data feeds.
Senators asked about methods from reimbursing chronic care patients and those seeking advanced care directives. Slavitt said the CMS is looking to expand methods for reimbursing providers at higher rates for chronic patients, as was recently implemented with Medicare Advantage.
He also suggested further encouraging alternative payment models such as bundling, medical homes and team-based and prevention models.
“We need to get out of the mode of paying physicians just to run tests and prescribe medicines,” he said.
