Despite initial widespread interest from small doctor practices, the CMS expects few will take advantage of a policy that allows them to partner to comply with MACRA.
In a notice posted Friday, the CMS estimates that only 16 virtual groups made up of 765 clinicians will launch by Jan.1, 2018 to comply with the merit-based incentive payment system (MIPS) under MACRA, which is the first year virtual groups are allowed to operate.
In comparison, up to 418,000 physicians will be submitting 2017 MIPS data to the CMS.
To avoid penalties outlined by the Medicare Access and CHIP Reauthorization Act, physicians must participate in either a merit-based incentive payment system (MIPS) or one of several advanced alternative payment models.
Solo and small practices can create "virtual groups" that would be evaluated under MIPS as one large entity.
But it can take up to three months to complete a virtual group agreement among partners clinicians told CMS, perhaps leading to the diminished interest.
The majority of stakeholders also indicated they may need at least six months prior to the start of the 2018 MIPS performance period to prepare IT and train staff by January 1, 2018.
Industry stakeholders are surprised by the low interest since there initially was buzz among clinicians to create such groups, but say it makes sense given that the CMS has yet to release a rule about how exactly virtual groups will work and what standards providers would have to meet.
And even if such a rule comes out soon, it may be too late to bring such groups together in time for a 2018 launch, according to Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association.
Industry insiders say there are still many providers who have not even heard of MACRA, MIPS let alone the concept of a virtual group, according to medical practice consuntant Tina Colangelo.
There's also the issue of agreement.
"In my experience, it's very challenging to get physicians to cooperate within the same organization due to schedule conflicts, their patients' needs and administrative tasks," Colangelo said.