Late last week, CMS issued what appeared to be a reprieve for providers concerned about the transition to MACRA. A September 8 blog post published by CMS Acting Administrator Andy Slavitt seemingly put some control back in their hands by introducing several less burdensome options for reporting MIPS data in 2017.
Within 24 hours of the blog post’s release, we began hearing from provider organizations that MIPS penalties are off the table for the 2017 performance year, based on Slavitt’s comment that “choosing one of these options would ensure [providers] do not receive a negative payment adjustment in 2019.”
In light of that, it may be tempting to hit the snooze button on MACRA. But providers who do so could pay for it later by prolonging their unpreparedness. The fundamentals have not changed — there are no shortcuts when it comes to MACRA.
MACRA’s Four Options
Slavitt’s blog post briefly describes four options for reporting MIPS data, and states that additional details will be published in the final rules, due out by November 1.
Option 1 – Submit “some” data and avoid negative payment adjustments. Here, CMS is basically saying it’s acceptable to opt out of the first year. What qualifies as “some” data remains undefined, as is the additional comment that this includes “data from after January 1, 2017.” Presumably this means that partial-year data will suffice in 2017, but that’s not entirely clear.
Option 2 – Participate for a portion of the calendar year and qualify for a “small positive payment adjustment.” Apparently, this option will require the reporting of all MIPS data and not just “some” of it. It’s unclear what a “small” adjustment amounts to, and there’s also no word on downside risk.
Option 3 – Participate for the full calendar year and qualify for a “modest positive payment adjustment.” Just like “small,” there is no definition of “modest,” nor any word on downside risk.
Option 4 – Participate in an APM and skip the MIPS reporting requirement altogether.This option is not new, as the original legislation established the APM track as an alternative to MIPS. However, Slavitt’s blog post neglects to mention that providers won’t know until after the fact whether they have qualified for an APM, so not reporting MIPS data would be very risky indeed.
How Providers Should Respond
Since the MACRA final rules are due within about six weeks, it would be premature to jump to any firm conclusions from the CMS blog. In the meantime, we offer these three thoughts:
Don’t Assume That Penalties Are Off the Table
Slavitt’s comments seem to suggest that it’s possible for any provider to avoid penalties with these new participation choices. But nowhere in the blog post does it state that each option is available to every provider. It seems more likely that Option 1 will be available only to those providers who would otherwise be hardest hit by MACRA’s reporting requirements, such as smaller and rural practices.
Perhaps it is mere coincidence, but just two days prior to this blog post, Congress sent this letter to HHS Secretary Sylvia Mathews Burwell, urging CMS to ensure that all providers have equal opportunity to succeed under MACRA and “to consider flexibilities for all practitioners, including small practices” (emphasis ours).
Additionally, the language in the legislation – which CMS must comply with – doesn’t seem to allow for the elimination all negative adjustments. Because of MACRA’s budget neutrality feature, the only way CMS can award positive payment adjustments (above and beyond the $500 million in additional funding earmarked for the top performers) is if it also imposes negative payment adjustments upon lower performers. Since Slavitt is still advertising the possibility of positive adjustments in his new set of options, it would follow that some providers will still get hit with negative adjustments.
Be Very Careful About Options 2 or 3
Many providers are not prepared for MACRA and will want to opt out of risk by choosing Option 1, provided it is available to them. It’s not clear which providers will end up in Options 2 or 3, but we can reasonably predict that they will mostly be higher-performing, better-prepared organizations. But that means that providers who take on this risk probably won’t be representative of the industry as a whole, which could make it difficult for CMS to appropriately set MIPS performance thresholds. Similarly, because so much of MIPS scoring is relative, these providers will likely find it even more challenging than before to assess their competition and predict their own performance.
Don’t Hit the Snooze Button
Most importantly, providers must not use Slavitt’s blog post an invitation to inaction. Remember that CMS has only so much ability to maneuver within its legislative mandate, and that bigger penalties and rewards are in the offing in future years. Last week’s announcement does not diminish the need to prepare for that eventuality.
Determining how best to participate in MIPS or APMs, and maximizing performance under these tracks, is as important now as it was before CMS published its blog post. Those who take MACRA seriously now will be better positioned in the future, when the stakes get even higher.