MACRA Final Rule Increases Exclusions

Last week, in a somewhat surprising and unexpected move, CMS released the final rule for MACRA. Most had expected not to have a final rule until the first week of November. MACRA replaces the Sustainable Growth Rate (SGR) with a program designed to pay providers more for quality than quantity of care.

The fundamentals of the program appear to be largely the same, although it will take some time for the industry to digest the 2,400 page rule. The Quality Payment Program (QPP) under MACRA has two components: Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs).

APMs are intended for those providers who are already using value-based care models. MIPS is more of a transitional program to help fee-for-service providers move to value-based care. It utilizes updates to some familiar programs like PQRS and Meaningful Use to make it a little easier to digest.

The new final rule took into account feedback from the industry and providers that the program needed to be simpler, more flexible, and provide support for smaller practices.

In a blog post about the final rule, Andy Slavitt, Acting Administrator, CMS said, “Other than a 0.5 percent fee schedule update in 2017 and 2018, there are very few changes when the program first begins in 2017. If you already participate in an advanced APM, your participation stays the same. If you aren’t in an advanced APM, but are interested, more options are becoming available. If you participate in the standard Medicare quality reporting and Electronic Health Records (EHR) incentive programs, you will find MIPS simpler. And, if you see Medicare patients, but have never participated in a Medicare quality program, there are paths to choose from to get started. The first couple of years are aimed at getting physicians gradually more experienced with the program and vendors more capable of supporting physicians. We have finalized this policy with a comment period so that we can continue to improve the program based on your feedback.”

The final rule also expands the exclusions, and according to Slavitt, this mean that than half of physicians in practices of 10 and under won’t need to participate. The MACRA final rule excludes eligible doctors who have under $30,000 in Medicare Part B allowed charges or 100 Medicare patients. The $30,000 is an increase from the proposed rule, which was set at $10,000.

Now that the final rule has been released, watch for regular updates on how the program works, what you’ll need to do in 2017 to participate, and who will be exempt.