Dr Kate Goodrich Discusses CMS Expectations for MACRA and APM Participation

CMS understands that not all physicians will report quality measures under the Medicare Access and CHIP Reauthorization Act (MACRA) or join advanced alternative payment models (APMs), especially immediately, said Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS. However, there are efforts in place to make it as easy as possible for these providers, which will hopefully increase participation over time.

Transcript (slightly modified)

Is there a percentage of physicians that you expect will not report at least one quality measure under MACRA and will be facing penalties?

We hope that that number is minimal. We really, again, our goal is to have very high participation in this program, but certainly there are likely to be at least some clinicians who make the decision, that for whatever reason, that they don’t want to participate in the program. There may be some clinicians who aren’t aware of the program who don’t participate, although we’re really working hard to get the word out to every physician and eligible clinician in the country about this, using a lot of our surrogates and counting on the specialty societies and state medical societies to help with that.

But certainly, there is likely to be what we hope is a very small percentage of people who don’t do anything, and if you don’t participate at all, don’t send in any data, and you are eligible for the program, so you don’t go below the low-volume threshold for example, then you will get a 4% penalty.

How many physicians do you expect will be in advanced APMs under MACRA?

We think for 2017 that the number of clinicians that will be in advanced APMs is somewhere probably between 90,000 and 120,000. We hope that that number, we’re aiming for that number to increase significantly by 2018, so we could have as many as 200,000 to 250,000 clinicians be in advanced APMs.

Now again, remember in order for them to be exempt from MIPS [Merit-based Incentive Payment System] they have to have a certain percentage of their revenue from Medicare coming through that advanced APM, or a certain percentage of their patients being attributed to that advanced APM. But we’re optimistic with some of the things that we do plan to put in place over the next year, that will allow more and more clinicians to be eligible for these advanced APMs.

And then over time, of course, we anticipate that growing even further, particularly as the Physician Technical Advisory Committee, or the PTAC, is receiving applications for new physician-focused payment models. We anticipate a lot of those are going to be specialty focused, and many of those we hope will ramp up over time so those numbers will grow even more.