Nearly a third of Medicare physicians could be exempt from Medicare's new merit-based incentive payment system (MIPS) under the final rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA). The rule was released today by the Centers for Medicare and Medicaid Services (CMS). 

In the final rule, CMS raised the low-volume threshold, so that providers with less than $30,000 in Medicare payments or fewer than 100 Medicare patients are exempt from the MIPS reporting requirements. The earlier proposed rule would only have exempted physicians with less than $10,000 in Medicare payments.

Other key highlights of the final rule include: 

• Restores the 0.5 percent payment update for 2017
• Reduces by half the number of measures that physicians must report, from 30 to 15.
• Lets physicians pick their pace of participation, and will not penalize physicians who at least attempt to report on a few measures
• Only requires physicians to report for 90 days in 2017 to receive a bonus
• Providers will not be scored on "resource use" (physician cost) in 2017
• Mostly eliminates the pass/fail system and will provide proportional credit.
• Expands the types of alternative payment models (APM) that can participate in MACRA, most notably Track 1 ACOs. The final rule also reduces the financial risk requirements for APMs.

Today’s final rule reflects additional steps taken by CMS to reduce the regulatory burden on physicians, but concerns remain. Physicians already spend 785 hours a year on quality reporting activities. For every hour physicians provide direct clinical face time with patients, nearly two additional hours are dedicated to paper and desk work.

“Physicians, particularly small and rural practices, need flexible and streamlined systems to support the high-quality patient care we provide,” said California Medical Association (CMA) President Steve Larson, M.D., MPH. “From day one, CMA urged CMS to delay the MACRA reporting period and provide a longer transition timeline for small medical practices and exempt them from penalties. We applaud today’s announcement, and we appreciate that CMS will offer full participation and bonus payment eligibility to medical practices ready for MACRA on January 1, 2017.” 

It is clear that CMS listened to physicians. The final rule is a vast improvement over current law and the initial proposed rule.

The final rule is nearly 2,400 pages – the result of a CMS listening tour with nearly 100,000 attendees and 4,000 public comments.

“CMA is reviewing and assessing the impact of the complex rule,” said Dr. Larson. “We remain committed to ensuring that MACRA allows more innovative, physician-led alternative payment models and lessens the reporting burdens on everyone.”

For a summary of the final MACRA rule, visit https://qpp.cms.gov.

Physicians can also visit CMA’s MACRA resource center to better understand the payment reforms and access resources to help with the transition. The center is a one-stop-shop with tools, checklists and information from CMA, CMS, AMA and national specialty society clinical data registries. CMA will add an updated summary and materials, including additional webinars, to the resource center in the coming weeks.

View the CMA resource center at MACRA resource center.