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MACRA gives rise to need for virtual groups that enable small practices to pool resources, AHA and AAFP say

By Marlee Rosen
October 2016

MACRA virtual groups AHA

Virtual groups that would allow solo physicians and smaller physician practices the ability to pool their resources when it comes to quality reporting and improvement have been pushed back to 2018 under the final MACRA rule released last week, placing small practices at a disadvantage when the law takes root in January, according to several medical practice advocates.

The American Academy of Family Physicians said it was shocked that virtual groups were not included in the final rule, saying smaller practices will suffer under the parameters of the MIPS program. The group cites actuarial findings from the Centers for Medicare and Medicaid Services, predicting that 87 percent of solo practitioners and nearly 70 percent of those in practices with two to nine physicians will receive a negative adjustment in 2019.

The final version of MACRA does include several flexibilities the government hopes will help small practices. For starters, 2017 will be a transition year to gives physicians time to adjust to the reporting requirements without risking penalties in 2017. The law also gives physicians the option of minimal reporting, 90-day reporting or full-year reporting. But the implementation of virtual groups was delayed at the 11th hour.

AAFP claims he ability of solo and smaller groups to aggregate their data removes any methodology biases due to the potentially small number of Medicare beneficiaries. This, they said, could widen the gap between the little guys and larger practices or those with ties to health systems.

Akin Demehin, the American Hospital Association's director of policy, said he hopes CMS moves quickly cement virtual groups into the policy.

"We understand CMS' desire to have a little more time to examine the details," Demehin explained. "That being said, we don't want them to put this off indefinitely.

"Conceptually, we think virtual groups are a really good idea," he said. "We hear from our members that the resources required to collect quality data, and participate in improvement activities, are significant. Basically, CMS is is saying there's some infrastructure they have to built in order to operationalize the virtual group option. They felt like they weren't ready to pull the trigger. We understand making the virtual group happen is difficult, but we see some significant value."

Danielle Lloyd, vice president of policy and advocacy for healthcare improvement company Premier, was also disappointed that virtual groups won't get off the runway in 2017.

"Firstly, we do appreciate that CMS has altered the low-volume exclusion requirement to help protect the small practices," said Lloyd. "They changed it from $10,000 to up to $30,000 in charges, so if you have less than or equal to $30,000 you're going to be excluded from it. So we do appreciate that they have made that increase in the threshold, and that's going to protect small practices.

Lloyd also worries that said new administration coming into Washington may complicate the picture. Demehin said he expects a virtual group proposal to be floated by CMS sometime next year.

"We were still hoping they would implement the virtual groups," Lloyd said. "The low volume excludes those physicians from the program, whereas the virtual groups would allow them to say in the game but also protect them from the problems of low volume by allowing them to partner up with other clinicians."

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