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    MACRA’s virtual groups unveiled

    Discussed since the initial rollout of the Medicare Access and CHIP Reauthorization Act (MACRA), “virtual groups” were seen as a key mechanism for small practices to assist with the burden of reporting Medicare performance metrics.

    The groups were established in the initial MACRA rule in the fall of 2016, but not further defined until just recently with the release of the proposed rule for participation in 2018.

    But even as the Centers for Medicare & Medicaid Services (CMS) has provided clarity on how the groups will operate, their immediate future appears a bit murky. And healthcare experts are divided on their effectiveness.

    Kelly Kenny, JD, chief executive officer for the nonprofit Physicians Advocacy Institute, told Medical Economics the concept of virtual groups has potential to provide greater flexibility and opportunities for solo and small practices, regardless of location and specialty.


    Related: Top 8 things doctors need to know about 2018 MACRA proposed rule


    “The virtual groups option allows solo physicians and small practices to participate in [the Quality Payment Program] while maintaining their independence, providing an opportunity to achieve meaningful cost savings and quality improvements, while also adding the potential for additional funding opportunities for these practices and physician,” Kenny said.

    However, not everyone is as optimistic. David J. Zetter, PHR, SHRM-CP, founder and lead consultant for Zetter Healthcare Management Consultants in Mechanicsburg, Pennsylvania, said he simply does not see the benefits of practices essentially “getting into bed together” to determine how they are paid and rated.

    “I have clients all over the country and have not had one client interested or mention forming a virtual group at this point,” he told Medical Economics.

    Virtual groups: What are they?

    To participate in one of MACRA’s two tracks—the Merit-based Incentive Payment System (MIPS)—solo physicians and those in small practices can report their metrics via virtual groups, to report across all performance categories: quality, clinical improvement activities, cost and advancing care information.

    The goal is to give these physicians a means to partner to meet the burdens of reporting the required performance metrics by working with peers in a similar situation.

    In the 2018 proposed rule for MACRA, CMS defines virtual groups as solo practitioners and groups of 10 or fewer MIPS-eligible physicians who join up with at least one other solo doctor or group to participate for one performance year.

    In a fact sheet issued with the proposed rule, CMS noted its goal was to, “make it as easy as possible for virtual groups to form no matter where the group members are located or what their medical specialties are.” But it made clear that these groups would be required to meet the same measure and performance category requirements as non-virtual groups.

    How do doctors report data?


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