Republican lawmakers are warning the CMS that if its draft rule on the new physician payment framework is finalized as is, small practices may close their doors, leading to more consolidation and higher healthcare costs.
A group of Republican physicians in Congress wrote to the CMS (PDF) just weeks before a final rule is expected. When MACRA goes live in 2019, it promises bonuses for top-performing doctors and clinicians and negative incentives for underperformers on a variety of measures, especially quality of care.
The lawmakers urge the CMS to be flexible by lowering patient minimum reporting thresholds.
The agency wants providers to report quality measures on 90% of their patients from all payers, and 80% of Medicare patients. Currently, only 50% of Medicare patients are required. Small providers would have a harder time obtaining the information technology and data needed to demonstrate that quality.
“Such a high minimum threshold would be impossible for many physicians, particularly those in small practices to meet,” the lawmakers said.
They recommended that the CMS maintain the minimum threshold at a maximum of 50% of Medicare patients.
The CMS should also broaden its Merit-based Incentive Payment System (MIPS) exclusion for providers who treat a low volume of Medicare patients. To help ease the impact on small providers, the CMS has proposed exempting physician practices that take in less than $10,000 in Medicare charges and fewer than 100 unique Medicare patients per year.
However, an AMA analysis found that just 16% of all MIPS-eligible clinicians would be exempt under the proposal.
The CMS should consider increasing the threshold to $30,000 in Medicare allowed charges or fewer than 100 unique Medicare patients. This would exclude 30% of physicians.
If a physician faces penalties, he or she should be able to clearly understand the appeals process and not have it be burdensome, the lawmakers said. More than 80% of solo practitioners should expect their reimbursement to fall, according to government projections.
The letter mirrors comments submitted by many providers and they are thrilled with the support, said Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association.
But whether the CMS will heed these concerns is unclear. The agency sent the final rule to the Office of Management and Budget on Sept. 16. That's one of the last steps before approval. The CMS expects to release the final rule by Nov. 1.
Travis Broome, healthcare policy lead at Aledade, a value-based care company that partners with independent practices participating in alternative pay models, said he hopes providers' comments already swayed the CMS' opinion on these issues. But the agency can still submit updated language to the OMB, he said.