CMS gives 800,000 docs a pass on MACRA requirement

More than 800,000 clinicians will not have to comply with Merit-based Incentive Payment System reporting requirements outlined in MACRA, which may save them millions collectively in compliance costs.

The majority of physician practices were expected to use the Merit-based Incentive Payment System, known as MIPS, to comply with MACRA as opposed to alternative pay models. Under MIPS, payments would be based on a compilation of quality measures and use of electronic health records.

The CMS has now sent letters to 806,879 clinicians saying that they will not be evaluated under MIPS in 2017.

That's a bump from the CMS' estimates in the final MACRA rule released last October. At that time, the agency calculated that as many as 780,000 clinicians would not have to comply with MIPS requirements. Up to 642,000 physicians were slated to submit MIPS data, but that number has now dropped to 418,849.

The agency said it used an updated formula to estimate providers' Medicare revenue, which changed the final participation numbers, a CMS spokeswoman said.

The CMS has estimated MACRA compliance will cost the healthcare industry up to $1.3 billion.

The exempted physicians include those with less than $30,000 in Medicare charges and fewer than 100 unique Medicare patients per year are exempt from complying with MIPS. Clinicians new to Medicare this year are also exempt this year.

The agency also gave a pass to providers who have implemented a MACRA-compliant Advanced Alternative Payment Model, which is the other value-based reimbursement track doctors complying with the law can choose.

Under MIPS, physician pay will be based on success in four performance categories: quality, resource use, clinical practice improvement and "advancing care information" through use of health information technology. The advancing care criteria is based on the government's meaningful-use program, which is used to decide whether doctors should be rewarded for using EHRs.

Medicare reimbursement for providers in 2019 will be based on how well doctors perform on these metrics this year. Under MIPS, physicians can earn a bonus or penalty of 4% of their reimbursement in 2019.

Doctors have been anxiously waiting to find out if they were going to have to report under MIPS after the CMS missed the notice deadline in December as it rewrote the letters.

That delay could have affected some doctors' bottom lines, as they may have spent money to upgrade EHRs and administrative procedures to implement MIPS only to be told they didn't need to, according to Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association.

"With so many exceptions, physicians need to know their status prior to the performance year," Gilberg said. "CMS notifying physicians and group practices in May of the performance year creates confusion and needless frustration."