Special Capitol Hill Report: CMS Announces Final MACRA Rule

October 14, 2016

By Daniel Spirn, AAN Regulatory Counsel 

New Medicare Rule Links Neurologist Payments to Quality and Outcomes, Addresses AAN Concerns
On Friday, October 14, the Centers for Medicare & Medicaid Services (CMS) released its final rule that links Medicare provider payments to quality patient care under the Medicare Access and CHIP Reauthorization Act of 2015, also known as MACRA. The AAN submitted comments to CMS on its proposed rule earlier this year. CMS responded to our concerns with a number of changes in the final rule, including an option for neurologists to select their own pace in the first year of this new payment program.

AAN President Terrence L. Cascino, MD, FAAN, expressed the importance of this rule for neurologists. “It is crucial that the AAN does everything it can to ensure neurologists-especially those in solo and small practices-can succeed in MACRA, and we are doing exactly that. We have devoted significant resources advocating to CMS and made extensive comments to improve the regulations and decrease regulatory hassles. At the same time, we have been educating our members and developing tools to help members participate. I'm very pleased that CMS has responded to our concerns and has incorporated our feedback into the final ruling. They agreed to reduce burdens, allow flexibility in reporting, and boost support for small practices. We still want to see improvements that streamline MIPS and more opportunities for neurologists to participate in Advanced Alternative Payment Models (APMs). We have been proactive and are currently working on APMs of our own that we will bring to the government in the near future,” he said.

The changes to Medicare physician payment are some of the biggest reforms to neurologic reimbursement in years. Important details about this rule include:

  • Finalizes the creation of a two-track system for Medicare reimbursement: the Merit-based Incentive Payment System (MIPS), for neurologists who are reimbursed through fee-for-service, and an Alternative Payment Model (APM) option
  • A scaled approach allowing neurologists to participate at different levels in the program based on their readiness in 2017
  • Additional resources to help small and solo practices tackle the challenges of the new payment system
  • The establishment of a low-volume threshold that CMS estimates will ultimately exclude nearly 25 percent of Medicare-participating neurologists from the first year of the program 

Read the AAN Detailed Summary. 

The AAN has a variety of resources to help you prepare for these changes.

Learn five things you can do today to prepare for MACRA and see the AAN's video on payment reform. If you have questions, feel free to email us at





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