Republican Lawmakers Warn of MACRA’s Impact on Small Practices

A group of Republican lawmakers are urging the Centers for Medicare and Medicaid Services (CMS) to revise its proposed implementation of the Medicare Access and CHIP Reauthorization Act, or MACRA, of 2015, which they argue would complicate quality reporting and burden smaller practices.

“If CMS implements the rule in a manner which is inconsistent with Congressional intent, MACRA has the potential to overcomplicate an already burdensome and complex quality reporting system and take more time away from patient care,” the 18 GOP politicians wrote in an open letter to leading CMS officials. 

Under MACRA, more than 90% of providers will switch to the Merit-based Incentive Payment System (MIPS) in 2017. The lawmakers expressed concerns that, as proposed, every group practice will be required to spend time and resources self-monitoring at least 22 areas of their practice. They wrote that more work will be needed to make this system “not overly burdensome,” and that the final implementation should include feedback that is easy to understand as well as an appeals process that is simple and transparent.

The senators and representatives noted these issues out of concern for small and rural practices that may have a difficult time keeping up with the administrative demands of MIPS implementation. To this point, they called for CMS to reduce its proposed minimum reporting thresholds (80% of Medicare patients and 90% of patients from all payers) to the 50% of Medicare patients requirement that is currently required. 

Further, they proposed that CMS broaden the exemption cutoff for smaller practices from $10,000 in Medicare allowed charges and 100 unique Medicare patients per year, to $30,000 in Medicare allowed charges or fewer than 100 unique Medicare patients per year. This change would broaden exemption among MIPS-eligible clinicians from an estimated 16% to less than 30%, yet still subject more than 93% of allowed spending to MIPS, they wrote.

The letter noted that these and other issues concerning the draft’s “unrealistic” implementation timeline will likely encourage physicians to join larger organizations to reduce financial risk, thereby driving consolidation within health care, the lawmakers warned.

“By repealing the Sustainable Growth Rate Formula, MACRA has the potential to transform the health care landscape and the delivery of care,” Republican lawmakers wrote. “We strongly urge CMS to make necessary changes in the final rule so that physicians may be provided with the tools necessary to succeed under this new payment regime.” —Dave Muoio