What is the new budget’s impact on MACRA? March 12, 2018
On February 8, President Trump signed into law a bipartisan budget bill that is designed to extend through September 2019. Included in that bill were a number of items directly impacting the medical community, including independent physicians. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was also impacted by the new budget.
Jennifer McLaughlin, senior associate director of government affairs for the Medical Group Management Association (MGMA), in a discussion with Physicians Practice managing editor Gabriel Perna, indicated that she and her association were still “trying to dissect and understand how [the changes] will play out.”
One of the significant aspects of the new budget bill, McLaughlin says, is the repeal of the Independent Payment Advisory Board, or IPAB. This board was an “unelected panel that would not be accountable to voters or stakeholders.” IPAB would have been triggered after Medicare spending exceeded a certain threshold, as part of the Affordable Care Act (ACA).
McLaughlin also noted that the budget bill changes, for the most part, make implementation of MACRA much more sustainable. There are some small changes to the Merit-based Incentive Payment System (MIPS) that have a potentially big impact. Changes to the Cost category will be felt the most by independent physicians.
Within MIPS, the Cost category “continues to be a source of confusion for physician practices … because there hasn’t been a ton of discourse coming from CMS about how it will be measured over time.” Independent physicians and organizations like MGMA did not have the opportunity to work with the Centers for Medicare & Medicaid Services (CMS) before the MIPS program was implemented, to work on the Cost category details.
One of the more positive aspects of the budget bill and its impact on independent physicians and MACRA is a tweak to the language specifying that any MIPS bonuses or penalties will not extend to Part B drugs, McLaughlin noted. Since reimbursement of Part B drugs just a passthrough for physicians, the new verbiage should be beneficial for independent physicians as they calculate costs.
Although McLaughlin states that the new budget bill “gives CMS more time to clarify, test, and develop episode-based cost measures,” independent physician practices are still struggling to determine how the cost category will impact them.