More Small Practices Exempt from MACRA Under New Draft Rule

Under a new draft rule, the Centers for Medicare and Medicaid (CMS) would exempt physician practices with less than $90,000 in Medicare revenue or fewer than 200 unique Medicare patients per year from complying with the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. The original threshold was $30,000 or fewer than 100 Medicare patients. Combining this new rule with the exemptions already in place, a total of approximately 834,000 more clinicians are excluded from complying with the quality reporting program under MACRA. While CMS estimates only 37 percent of 1.5 million Medicare clinicians now billing under Medicare will be complying with the quality reporting system under MACRA, experts say the move should not be viewed as CMS undermining value-based care. “This should not be taken as a sign that physicians are going to go back to the fee-for-service way of doing business,” said Christopher Stanley, director of the healthcare practice at consulting firm Navigant.

Under MACRA, physicians can avoid penalties by following one of two payment tracks: the Merit-based Incentive Payment System (MIPS) or advanced alternative payment models like accountable care organizations (ACOs). Currently, there has been little interest in the MIPS option. However, CMS estimates the number of participating clinicians in alternative payment models will double next year, totaling 180,000 to 245,000, because more doctors are expected to participate in ACOs.