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CMS Doctor Pay Rule Timeline May Allow for Few Major Changes

By Kerry Young, CQ Roll Call

June 27, 2016 -- A November deadline for creating a new Medicare payment system for doctors may leave federal officials little time to significantly change a draft proposal, predicted an Association of American Medical Colleges (AAMC) official.

The Centers for Medicare and Medicaid Services (CMS) might ease some of the proposed reporting requirements for doctors, but may leave much of its initial proposal intact, said Gayle Lee, director of physician payment policy for the AAMC, in an interview. The agency is required by law to finalize the rules by November if officials intend to implement them when the new payment year begins in January.

CMS unveiled the proposed rules in April. More than 3,000 responses were submitted before a Monday deadline, according to CMS.

"I think there will be tinkering, but the basics of what we've seen will be what they are finalizing," Lee speculated.

Many physicians appealed to the agency to shorten the reporting period for doctors who will be covered by the most common reimbursement approach, the new merit-based incentive payment system. Instead of looking at a full year of data from doctors, a six-month period could be used, she said.

"It's possible CMS may be open to that, although there are concerns with the reliability of quality measures when you reduce the length of the performance period to a shorter period of time," she said.

The rule will carry out the mandate set in last year's overhaul of physician pay (PL 114-10), known as the Medicare Access and CHIP Reauthorization Act. A key concern with MACRA has been helping doctors in small practices adapt to the new reporting requirements. Groups representing doctors have sought to persuade CMS to reconsider the standards for qualifying for alternative payment models, which may prove more profitable in the long term for doctors.

The American College of Rheumatology on Friday told CMS that few of the current alternative payment models work for their members, who treat severe cases of arthritis.

"Workable alternatives should be developed with attention to facilitating participation of small and solo practices," Joan M. Von Feldt, president of the ACR, wrote in the comment to CMS. "As currently written, the requirements for qualifying participation in APMs are formidable, and establish too high of an administrative burden."

The rheumatology association also asked that CMS delay the effective date of the first year for the new MACRA rules to 2018 rather than next year. Doctors do not have time to prepare to prepare for the new system, the group argued.

"One of the largest fundamental changes in Medicare reimbursement must be implemented in a way that allows everyone to evaluate, prepare, and implement these changes to their practice so that reimbursement accurately reflects performance," Von Feldt wrote.

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