Speaking before the Senate Finance Committee on July 12, 2016, Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt told lawmakers that the agency is considering delaying the start date for Medicare payment reform because of concern that small practices may not be ready for changes under the Medicare Access and CHIP Reauthorization Act (MACRA). During the hearing, lawmakers in both parties expressed concerns about the impact the proposed rule will have on small practices and their ability to successfully participate.

Both the California Medical Association (CMA) and the American Medical Association (AMA) have sent letters to CMS encouraging the agency to delay the first MACRA reporting period for physician practices that need more time. It is currently set to go into effect on January 1, 2017. However, CMA supports allowing physician groups who wish to start on January 1 to do so.

The agency is also considering raising the current reporting threshold that would keep doctors who only see a few Medicare patients from being subject to the new reporting requirements. Currently, physicians who have $10,000 in Medicare charges and 100 patients will be required to report under MACRA.

Slavitt said the agency had received "significant feedback" on these issues. "Some of the things that are on the table, [that] we're considering include alternative start dates, looking at whether shorter periods could be used, and finding other ways for physicians to get experience with the program before the impact of it really hits them."

“The focus on small independent practices and their ability to continue practicing independently is a very important priority for us,” he said.

AMA President Andrew Gurman, M.D., said in a statement that he was “heartened” by Slavitt’s testimony. “Successful implementation will require flexibility, and indications are that CMS intends to work toward the goal of giving physicians a fair shot in adjusting to this new policy framework,” Dr. Gurman said.

"We are in complete agreement that CMS's regulatory framework must focus on patients, increase flexibility, reduce administrative burdens, and concentrate on aspects of health information technology that are critical for delivery system reform and improving patient outcomes."

Last week CMA submitted comprehensive comments to CMS outlining constructive improvements for the implementation of MACRA in California. CMA’s MACRA Technical Advisory Committee developed over 40 practical recommendations to simplify and improve the implementation of MACRA. In addressing the issue of participation for small practice and solo practice physicians, CMA suggested that the initial reporting period be moved back one year to January 1, 2018, and that CMS significantly expand the permanent low-volume exemption for small practice physicians and physicians located in health professional shortage areas, as well as provide a voluntary phase-in transition path for small practices to successfully participate.

For more information on MACRA, see CMA's MACRA resource center.