MACRA proposed rule: Good intentions from CMS but a burden for small practices, says doc

The rule would replace meaningful use for physicians, but represents a 'whole new set of complications.'
By Jessica Davis
01:32 PM
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John Goodson, MD

Many physicians have waited with bated breath for the end of meaningful use, looking forward to a new era of less burdensome compliance requirements and more realistic reporting guidelines.

But after closely reading the Centers for Medicare and Medicaid Services' thousand-page proposed rule for the Medicare Access & CHIP Reauthorization Act of 2015, or MACRA – which would sunset meaningful use for Medicare physicians – it seems many providers are realizing it's not quite the fix they had in mind.

While it's apparent CMS had "good intentions" when it crafted the proposed ruling, there are a lot of things the agency failed to consider, John Goodson, MD, staff internist at Massachusetts General Hospital and associate professor at Harvard Medical School told Healthcare IT News.

"What's happening with MACRA is transformational: It's the biggest thing since the Resource-based relative value scale," Goodson said.

But just as "CMS didn’t consider how RBRVS - could tank providers," the results of which are playing out right now, he said, the agency may have missed its mark here too. RBRVS stands for resource-based relative value scale.

According to John Squire, president and chief operating officer of Amazing Charts, a developer of ambulatory EHRs and practice management tools, there are two potential victims if the ruling is passed as is: small practices and Medicare beneficiaries.

"By basing penalties on outcomes, you may be ranking some of these physicians on circumstances out of their control," Squire said. "There are behavioral things a physician can't control. And it doesn’t allow for any exemptions, outside of low-volume."

[See also: Healthcare industry reacts to sweeping MACRA proposal, with its big changes for physician IT.]

MACRA also removes the option for providers to opt-out of reporting by paying a penalty, which means all providers who accept Medicare patients must comply.

Many small practices won't be able to keep up, he said. And according to Goodson, "Providers are being put in a position where it's unattainable."

"One unintended consequence, which happened with meaningful use, is some will look at the list of requirements and feel inundated," said Squire. "They'll just say, 'The heck with it; I'll just stop accepting Medicare patients or require cash-only.'"

Furthermore, the rule sets a very high barrier for practices hoping their existing participation in accountable care organizations counts for the MSSP, Medicare Shared Savings Program path, rather than  requiring them to attest for the Merit-Based Incentive Payment System, or MIPS.

Squire said, "Providers who have already bought into this risk-sharing model are crying foul: 'I've designated resources to it and you're saying that it doesn’t matter.'"

[See also: MACRA-economics 101: Prepare today for tomorrow's outcomes.]

While Goodson recognizes CMS has a difficult task in responding to the pushback from the industry, he also recognizes that healthcare is "embarking on a whole new set of complications and implications.

"Quality is really focused around recording, but another piece is built around data interchange," Squire said. "Physicians need to weigh how their systems support MACRA – and let the technology do the work to relieve the burden for the provider. It's your practice methodology that would need to adjust."

"A lot of people think this is going to be a whole new system," said Goodson. "But it's just a modification of the current system. This is a new complicated set of recording needs."

Twitter: @JessiefDavis