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Rheumatology Community Responds to MACRA Proposed Rule, Acknowledges CMS Efforts to Increase Flexibility and Reduce Regulatory Burdens

Rheumatologists express support for additional MIPS exemptions, extension of “Pick Your Pace” flexibility, delay of EHR requirements and decision to keep the cost performance category weighted at zero for an additional year

ATLANTA – The American College of Rheumatology (ACR) today welcomed components of a new proposed rule from the Centers for Medicare & Medicaid Services (CMS) regarding the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program (QPP) as containing several positive developments for rheumatology providers. Specifically, rheumatologists expressed support for CMS’s proposals to increase the threshold for Merit-Based Incentive Payments System (MIPS) exemptions, to extend “Pick Your Pace” flexibility for another year and to delay electronic health records requirements. Additionally, the ACR supports keeping the cost performance category weighted at zero for another year beyond 2018.

Initial review of the proposed rule suggests that CMS has been listening to many concerns of the rheumatology community.  “The ACR has made it a priority to provide CMS with constructive feedback on how to make MACRA successful for rheumatology practices, so we are pleased and encouraged to see CMS address these concerns by offering more flexibility,” said Dr. Sharad Lakhanpal, MBBS, MD, a practicing rheumatologist and president of the ACR.  “We believe a user-centered approach is critical to ensure the continued provision of high-quality rheumatologic care, and look forward to continued engagement with CMS on this issue.”  

The proposed rule would expand the number of physician practices who are exempt from the Merit-Based Incentive Payments System (MIPS) reporting requirements to include practices with less than $90,000 in Medicare revenue or fewer than 200 unique Medicare patients per year. Further, the proposed rule provides bonus points that are added to the final scores of MIPS for eligible clinicians who are in small practices as well as a hardship exemption from the advancing care information performance category.

The ACR supports these changes as they will help alleviate administrative burdens placed on small practices who deliver vital rheumatologic care to rural and underserved populations.

The ACR also supports the continuation of the “Pick Your Pace” flexibility program into the 2018 performance period. With extension of that program, practices could avoid penalties in 2020 if they submit some quality data to the program in 2018. Extending this program into next year’s performance period will ease the transition period for providers as they move into full compliance with the Quality Payment Program.

Additional changes outlined in the proposed rule, such as continuing to allow providers to use 2014 Edition certified electronic health records (CEHRT), maintaining the cost performance category weighted at zero for an additional year and increasing the availability and adoption of Advanced Alternative Payment Models were also welcomed by the rheumatology community.

“The ACR appreciates CMS listening to its concerns and improving provider flexibility with regards to MACRA requirements,” said Dr. Angus Worthing, MD, a practicing rheumatologist and chair of the ACR’s Government Affairs Committee. “We will continue to thoroughly review the proposed rule and submit official comments to CMS in the coming weeks.”  In the meantime, the ACR has developed a number of resources to help rheumatologists understand MACRA, and will continue to update members as new information becomes available.

Jocelyn Givens
404-633-3777, ext. 810


The American College of Rheumatology (ACR) is the nation's leading advocacy organization for the rheumatology care community, representing more than 9,500 rheumatologists and rheumatology health professionals. As an ethically driven, professional membership organization committed to improving healthcare for Americans living with rheumatic diseases, the ACR advocates for high-quality, high-value policies and reforms that will ensure safe, effective, affordable, and accessible rheumatology care.

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