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    CMS should exempt all—not just some—small practices from MACRA

    When payment reform under the Medicare Access and CHIP Reauthorization Act (MACRA) was unveiled last year, the government went out of its way to reassure small practices that they had nothing to fear. In fact, they made more than 800,000 physicians exempt from the program altogether as they didn’t treat enough  Medicare patients or collect enough in charges.


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    Then the Centers for Medicare & Medicaid Services (CMS) took it a step further, announcing “pick your pace,” where any participating physician—including solo and small practices still left in the program—simply had to submit one piece of data on their patients this year to avoid a penalty. If you submitted more data, you could also earn a bonus.

    And the reaction was overwhelming from solo and small practice physicians: What’s MACRA again? 

    In June, CMS unveiled its proposed rule for the program in 2018, affecting payments in 2020. They extended the exemptions—excluding another 134,000 physicians nationwide—and also eliminated “pick your pace,” requiring physicians to submit more data, but also giving flexibility in the volume and letting smaller practices submit the data they felt was most important.  

    CMS is confident that this added flexibility will lure 90% percent of all Medicare-eligible practices (including solo and small practices) to participate. 


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    The early verdict from physicians is simple: “MACRA? I think I know what that is, but I’ll pass, thank you.”

    For some, they have no interest in becoming mass data producers for the government, likely meaning technological upgrades and staff changes. For others, they simply don’t think the metrics truly measure patient improvement. The reaction from smaller practices to MACRA has been tepid at best. 

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    • Anonymous
      So, if we wanted to contact CMS or someone who had some influence on this matter, who should we contact?

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