Whitfield L. Knapple, MD, FACG Chair, ACG National Affairs
Whitfield L. Knapple, MD, FACG
Chair, ACG National Affairs

Highly Anticipated MACRA Final Rule Hits

October 14, 2016 – Today, the Centers for Medicare and Medicaid Services (CMS) released the highly anticipated final rule outlining details of Medicare reimbursement reform beginning next year.

In a press conference this morning, Acting CMS Director Andy Slavitt outlined the changes to help physicians participating in Medicare’s transition under MACRA.  The full text of the final rule is available online and CMS has provided an Executive Summary.

The College is reviewing the details of the more than 2,400 page final rule which creates a new Medicare Quality Payment Program, replacing the Sustainable Growth Rate (SGR) formula for physician reimbursement.

Here are some key take-aways:

Resource Use MIPS Category 
The resource use component of the Merit-based Incentive Payment System (MIPS) has been reweighted to zero for 2019.

“Pick Your Pace” Included in Final Rule
Under the final rule, 2017 is considered a “transition year.”  The rule finalizes plans announced in September by CMS to ease reporting requirements in CY 2017 in order to mitigate the number of providers who would be subject to payment cuts in CY 2019. According to the rule, any effort to participate in MIPS will insulate providers from a reimbursement cut in CY 2019.

Easier to Join APMs: “Track 1 Plus” 
The final rule creates another category of Advanced Alternative Payment Models called “Medicare ACO Track 1 Plus” to limit the amount of downside financial risk APM participants.  According to CMS, this new APM would be a test payment model that would still be considered an “Advanced APM” but would incorporate more limited downside risk than is currently present in other Advanced APMs. CMS will announce additional information about the model by January 2017.

Estimated MIPS Impact on GI
CMS revised its estimates for GI. The agency now estimates that 95.6 percent of eligible GI MIPS participants will avoid a payment cut in 2019, up from an estimate of 62% in the proposed rule.

ACG Has Your Back on MACRA
Since the proposed MACRA rule was released in April 2016, ACG has provided members with a detailed summary and issued concise, strategic, weekly “MACRA Tidbits” to help simplify these complicated proposed reimbursement reforms.

On your behalf, the College submitted extensive official comments to the agency in June 2016 urging CMS to reduce administrative and financial burdens to GI practices.  It appears that CMS has heard at least some of ACG’s call for changes to MACRA, but we are still reviewing the particulars.

APMs and MIPS on the Agenda at Today’s Practice Management Course in Las Vegas
The release of the final rule is very well-timed as ACG members attending the 2016 ACG Annual Scientific Meeting and Postgraduate Course will learn about the details of this rule, the changes from the proposed rule, and glean strategies and insights on how to adequately prepare your practice for these upcoming changes. From MACRA, to MIPS, to APMs, attendees will be among the first to learn about this breaking news the final policies for CY 2017 and beyond.

Stay Tuned
ACG will soon have detailed information and in-depth analysis on how these new mandates will impact your practice.

For more details on how to avoid a payment cut in 2019 under MIPS, here is a quick overview.