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Capitol Hill Report: MACRA Proposed Rule: How Will It Affect Small/Solo Practitioners?

May 9, 2016

By Daniel Spirn, Regulatory Counsel

AAN Scrutinizing CMS Proposed Rule on MACRA
It was just over a year ago when the AAN celebrated the repeal of the Medicare sustainable growth rate, commonly known as “SGR” or the “doc fix.” In its place, Congress enacted the Medicare Access and CHIP Reauthorization Act of 2015, also known as MACRA. The law fundamentally changes how Medicare pays physicians and other clinicians who participate in the program. On April 27, the Centers for Medicare & Medicaid Services (CMS) released its initial plan to implement MACRA, and now the AAN and other stakeholders will comment on the proposal. We expect CMS will issue its final rule this fall.

We are encouraged by the proposed changes that move from a highly prescriptive to a more flexible model. This is especially evident in some of the quality and electronic health record components of the proposal. But the AAN is concerned with the impact this could have on small and solo practitioners. We are also mindful that the first performance year for the proposal begins in 2017. This does not leave us much time. AAN staff continues to work hard educating members about the upcoming changes and we will submit comments to CMS that reflect the best interests of neurologists in order to influence the agency's final rule.

The 962-page proposed rule aims to link Medicare provider payments to quality patient care. It establishes a “Quality Payment Program” to replace old reporting programs. CMS seeks to create a two-track system for Medicare reimbursement. The first is called the Merit-based Incentive Payment System (MIPS) and a second track involves alternative payment models (APM). You can learn more about the MIPS and APM tracks established by CMS at the AAN's website.

Because of the high bar set to qualify for the APM track, CMS projects that only 30,000 to 90,000 clinicians will be in the APM track. An estimated 687,000 to 746,000 physicians will be in MIPS, including an estimated 13,000 neurologists, according to CMS projections.

If you are looking to learn more about what you can do to prepare for these changes, the AAN website offers five steps that can be taken today. You also can view the AAN's video on payment reform. CMS has also published some helpful information, including a web page, fact sheet, and video explanation on the proposal. As always, if you have questions or concerns, feel free to email us.


Making the Rounds: Educating Congress and Neurologists in Florida
By Mike Amery, Esq., Senior Legislative Counsel, Federal Affairs

As CMS released the MACRA Rule, Congress left DC and so did I.

My first stop was a retreat with the Main Street Republican Partnership (RMSP) in northeast Florida. The partnership includes more than 70 House Republicans and a few members of the Senate who are considered to be on the moderate side of the political spectrum. The AAN supports RMSP with a contribution from the AAN's political action committee, BrainPAC. The AAN also supports a similar Democratic “Blue Dog” Coalition. 

This year's retreat was led by House Energy & Commerce Committee Chair Fred Upton (R-MI) and was attended by 25 RMSP members. My goal was to talk to each one about the Furthering Access to Stroke Telemedicine (FAST Act), HR 2799, which would improve patient access to neurologists via telemedicine for individuals suffering from stroke.

The FAST Act was a key issue during the AAN's Neurology on the Hill in March, which significantly helped boost the profile of this bill on Capitol Hill. There are now 89 cosponsors of the FAST Act, including several from the Main Street group.

I followed up the Main Street event by presenting grand rounds on advocacy at the Mayo Clinic in Jacksonville. It was a great group of about 50, including many residents. We talked about the efforts AAN is making on influencing federal and state health care policy, the issues we are working on, and how AAN members can get involved.

We also had an excellent conversation about the primary elections. If you've heard me speak in the past, you know there is always a poll. The official winners of the Mayo Jacksonville presidential straw poll were Bernie Sanders for the Democrats and John Kasich for the Republicans.

A special thanks to Neurology Department Chair James Meschia, MD, and W. David Freeman, MD, graduate of the AAN's Palatucci Advocacy Leadership Forum, for the invitation!

 

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