Final MACRA Implementation Rule Addresses AAFP Concerns

Academy Pledges to 'Fully Prepare' Family Physicians

October 14, 2016 03:59 pm News Staff

It's been a long six months of anticipation for America's family physicians, but today HHS released the long-awaited final rule( that will implement the Medicare Access and CHIP Reauthorization Act (MACRA).

[Macro photo of tooth wheel mechanism with IMPLEMENTATION concept words]

"Today, we're proud to put into action Congress' bipartisan vision of a Medicare program that rewards clinicians for delivering quality care to their patients," HHS Secretary Sylvia Burwell said in an HHS news release.(

She noted that the implementation vehicle for the rule -- the Quality Payment Program( -- was "designed with input from thousands of clinicians and patients across the country."

Indeed, the AAFP worked tirelessly to steer the crafting of the final rule with an eye to supporting and protecting the key role family physicians play in the nation's health care system.

"The final rule addresses many of the concerns family physicians have expressed about the complexity of the program, the pace of implementation, new administrative burdens and the usability of technology," AAFP President John Meigs, M.D., of Centreville, Ala., said in a statement.

Story Highlights
  • HHS has released the final rule that will implement the Medicare Access and CHIP Reauthorization Act.
  • The final rule addresses concerns from family physicians about complexity, administrative burdens and technology.
  • The rule provides for $20 million in funding spread over five years to help train and educate physicians and other Medicare providers.

"In particular, we are pleased that practices with low volumes of Medicare Part B patients are excluded in the first year and that family physicians will be able to move toward full participation without suffering penalties that will slow their progress," he added.

Burwell asserted that implementation of the Quality Payment Program would "strengthen our health care system for patients, clinicians and the American taxpayer."

CMS Acting Administrator Andy Slavitt pointed to the rule's built-in flexibility aimed at allowing physicians to work at their own pace.

"Today's policies are designed to get all eligible clinicians to participate in the program so they are set up for successful care delivery as the program matures," he said in the HHS news release.

AAFP Responds to Final Rule

For months, the AAFP worked to shape MACRA into a tool that rewards family physicians for all the work they do to provide comprehensive care to their patients. Although AAFP experts are just beginning to analyze the final rule to prepare family physicians for its implementation, Meigs noted that it appears to take into account the Academy's guidance.

He gave a nod to the provisions in the rule designed to "smooth the way" for physician participation in the Merit-based Incentive Payment System and alternative payment models (APMs).

Utilize AAFP Resources, Succeed in New Payment Models

The AAFP has invested a significant amount of time and energy toward ensuring that family physicians are armed with everything they need to succeed in the value-based payment models under construction.

One of the AAFP's most popular resources is an FAQ document that gets to the nub of what physicians want to know about a very intricate and complicated program.

For instance, the very first question asks how MACRA will affect a physician's Medicare payments. It also answers questions about the Merit-based Incentive Payment System (MIPS), alternative payment models (APMs) and implications for small practices.

Check out this and a number of other tools that are ready and waiting from the AAFP.

"We're particularly pleased the rule implements and provides additional clarification regarding the 'pick your pace' system that allows practices to choose their reporting timeline for participating in the MACRA Quality Payment Program," said Meigs.

Small and solo medical practices, in particular, stand to benefit from the provision, he noted. And other flexibilities such as exemptions from certain penalties and allowances for patient-centered medical homes "will help low-volume practices."

The rule also provides for $20 million in funding spread over five years to help train and educate physicians and other Medicare providers about all elements of the Quality Payment Program, Meigs pointed out.

"This uniquely tailored assistance will help family physicians in individual or small group practices -- as well as those working in underserved areas -- identify appropriate technologies and quality measures, and help them evaluate their options for joining an Advanced APM(," he stated.

Most importantly, said Meigs, the kind of support outlined in the rule "will allow physicians to focus on what they do best -- taking care of patients."

MACRA Background

HHS released the proposed MACRA rule in April, and eight weeks later, after a meticulous review, the AAFP let the agency know that its proposal had missed the mark. In a 100-plus page comment letter,(107 page PDF) the AAFP laid out its view of how CMS could rein in the massive rule to make it workable for family physicians.

In today's statement, Meigs said, "The AAFP made several suggestions in response to the proposed rule, and we'll closely analyze the final regulation to identify CMS action on those comments."

He added that the AAFP's initial review of the final rule "indicates CMS has addressed many of our comments -- especially in regard to support for small practices."

Notably, HHS designated today's release as the "final rule with comment period" -- a designation that gives the AAFP and other interested stakeholders the opportunity to provide HHS with further input.

Stay tuned to AAFP News for more reaction from the AAFP after Academy experts have time to scrutinize details of the entire rule.