Doctors Hope Medicare Reporting Rule Doesn’t Add More Burdens

By Mindy Yochelson

Doctors are hoping a Medicare payment rule being reviewed by the Trump administration for 2018 maintains some of the reduced burden for quality reporting they were granted for the first year of the program.

Medical professionals and consultants told Bloomberg BNA March 30 that they’re optimistic but still cautious about proposed updates to Medicare’s quality payment program for next year (RIN:0938-AT13). The rule landed for review at the White House Office of Management and Budget March 22.

The Obama administration cut some breaks for medical professionals for 2017, the first year reporting was required under the new program. This includes how quickly and how much they must report quality measures. Professionals are pinning their hopes on receiving some of the same treatment from Health and Human Services Secretary Tom Price and Centers for Medicare & Medicaid Services Administrator Seema Verma.

An HHS spokesman indicated their wishes may come true. Price wants to ensure “that implementation is done in a way that does not place an undue burden on providers,” the spokesman told Bloomberg BNA March 28 when asked about the proposal under review.

Attention on Reporting Track

The quality payment program under the Medicare Access and CHIP Reauthorization Act of 2015 is a two-track system. Much of the focus about the proposal is centered on the reporting track, known as the Merit-Based Incentive Payment System (MIPS), which began Jan. 1. Most professionals are expected, at least in the first years of the program, to be in that track. Their scores for 2017 will affect whether they receive up to a 4 percent cut or addition on their Medicare payments in 2019.

Professionals can also choose to join the other track and be part of an advanced alternative payment model. This exempts them from MIPS and allows them to potentially earn a 5 percent bonus on their Medicare payments.

The CMS relaxed MIPS reporting requirements for 2017, following requests from doctors and members of Congress to simplify and slow implementation.

The 2017 final rule offered medical professionals a “pick your pace” choice of a participation level to help them avoid a cut in Medicare payments in 2019.

Doctors may choose to report on quality measures during any 90-day consecutive period as the minimum—rather than for the full year. They were also given the choice of reporting on a minimal number of measures.

Hopes for Next Year

“We are certainly hoping that 2018 looks a lot like 2017,” Katie Orrico, director of the Washington office of the American Association of Neurological Surgeons/Congress of Neurological Surgeons, told Bloomberg BNA. Because there’s still some confusion about the quality program, “maintaining the phased-in approach is essential,” she said.

The more limited reporting in 2017 allows the CMS to obtain a statistically valid sample for measuring quality but still reduce the reporting burden, Anders M. Gilberg, senior vice president, government affairs at the Medical Group Management Association, told Bloomberg BNA. He said he hopes this will continue under the proposal.

Without the efforts of Price, a physician and former chairman of the House Budget Committee, and members of the Republican doctors’ caucus, the 2017 final rule likely wouldn’t have been simplified to the extent that it was, he said.

John Feore, a director at Avalere, a Washington-based consulting company, told Bloomberg BNA the agency’'s new leadership may “enable continued or even greater flexibility implementing the program.” There could very well be continuation of “pick your pace,” even if it’s modified from 2017, he added.

The Cost Question

Observers also said they’re eager to see if one gap in last year’s rule gets filled in the 2018 proposal.

The CMS didn’t include “cost,” also known as resource use, though it’s one of the four performance categories on which doctors are scored under MIPS.

The four categories are quality, clinical practice improvement activities, meaningful use of electronic health records, and cost. The CMS wasn’t ready with a methodology for measuring cost, and professionals aren’t being scored on that category in 2017.

A big question is whether the agency will be ready to integrate cost into the formula in 2018, Gilberg said.

At some point, cost will have to be part of the equation, Feore said. But he said he won’t be shocked if it gets left out again in 2018.

Early Appearance?

The appearance of the proposed rule on OMB’s list of regulations under review in March was unexpected to some, although no one knows when it will be published in the Federal Register.

With CMS Administrator Verma’s confirmation on March 13 less than two weeks before the rule appeared on the OMB regulatory review list, the proposal was a surprise to some who thought she might want to spend more time on review. In addition, Price has been focused on congressional attempts to replace the Affordable Care Act.

“I’m a little surprised because I would’ve thought the new administration would review something like this closely,” Gilberg said.

Feore said he thought the proposed rule would show up closer to the summer.

Nonetheless, he added, it’s not time-consuming to make changes within the existing structure of the MIPS track of the quality payment program. The MIPS foundation was laid out in 2016, so much of what’s needed is changes to different weights and percentages used for scoring, he said.

To contact the reporter on this story: Mindy Yochelson in Washington at

To contact the editor responsible for this story: Kendra Casey Plank at

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