Implementation of some MACRA provisions could be delayed, CMS Acting Administrator Andy Slavitt told committee members at a July 13 hearing of the Senate Finance Committee.
Officials at the Centers for Medicare & Medicaid Services are considering “alternative start dates, looking at whether shorter periods could be used, and finding other ways for physicians to get experience with the program before the impact of it really hits them,” Mr. Slavitt testified.
Andy Slavitt
Many of the comments that were submitted by physicians and other stakeholders on the proposed MACRA rule called for delayed implementation, Mr. Slavitt said. Other key themes included ensuring that patients are the focus, simplifying the rules, creating more pathways to advanced payment models, and providing a greater consideration of the needs of small and solo practices, particularly rural ones.
“We need to launch this program so that it begins on the right foot. That means that every physician in the country needs to feel like they are set up for success,” Mr. Slavitt said. He added that CMS may release an interim final rule to allow for more comment on changes stemming from the feedback received on the initial proposal.
Many Senators on the committee asked Mr. Slavitt how the proposed regulations would impact solo and small practices, especially ones in rural areas.
“The focus on small independent practices and their ability to continue to practice independently is a very high priority for us,” Mr. Slavitt said. “I would add that it’s not just small practices, it’s all also any physician that practices in a rural location. They have a very different set of dynamics than other physicians do. ... We need every physician set up for success and the challenges in small practices are far greater.”
He noted that for many small or solo practices, even a small amount of additional paperwork could affect how much time the physician can spend with patients.
Another area of concern in the MACRA regulation comments was the delay in the development of virtual groups that would allow physicians to virtually pool reporting requirements to allow for greater participation in value-based programs. The proposed MACRA rule calls for these groups to be delayed for 1 year .
“I think this going to be a high priority for us, and I think it’s going to be something that is going to need a lot more input from physicians to make sure we get it right,” Mr. Slavitt said. Virtual groups are “a whole new way of reporting, and we need to make a number of decisions, and physicians would need to make a number of decisions and they are not yet used to practicing that way.”
He added that CMS is asking physicians how they want to go about it, and the feedback so far is promising that physicians want to participate, but there needs to be operational and technology infrastructure to make it happen.
“I don’t think this is something that can’t be solved with just a little bit more time, but it’s certainly not something that’s ready to be launched in months,” he said, adding that the agency aims to launch virtual group reporting in the second year of the MACRA implementation.