What independent physicians need to know about the MACRA final rule

What independent physicians need to know about the MACRA final rule

The Centers for Medicare & Medicaid Services (CMS) has just released its final rule for the 2018 Physician Fee Schedule as well as it final rule with comment period for the Quality Payment Program (QPP). The final rule for 2018 affects physician payments in 2020 under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

In announcing the new rules, Seema Verma, Administrator of CMS, stated that “these rules move the agency in a new direction and begin to ease that burden by strengthening the patient-doctor relationship, empowering patients to realize the value of their care over volume of tests, and encouraging innovation and competition within the American healthcare system.”

While the first year eased the burden for independent physicians somewhat with a “Pick your Pace” option for MACRA’s Merit-based Incentive Payment System (MIPS), the final rule requirements include evaluations based “in part on their cost cutting measures during the second performance year.”

CMS recognizes the burden placed on many independent physicians, particularly those in rural practices. The final rule includes “a number of policies designed to provide clinicians with a smoother transition to the Quality Payment Program (QPP),” according to a recent news release.  One change includes a decrease in the number of clinicians required to participate. An option has been added to “help clinicians and small, rural practices join together and share the responsibility of participating in value-based payments.”

CMS has also published a fact sheet detailing the highlights of the Final Policy, Payment, and Quality Provisions in the Medicare Physician Fee Schedule for Calendar Year 2018. In part, the fact sheet states that the “Medicare Physician Fee Schedule final rule includes the following as part of this initiative:

  • reducing reporting requirements
  • removing downward payment adjustments based on performance for practices that meet minimum quality reporting requirements

The final MACRA rule include the provision that independent physicians may continue to use the 2014 edition of certified electronic health records (EHRs) for MIPS.