The Centers for Medicare and Medicaid Services (CMS) has published this fact sheet describing how small group physician practices (defined as practices with 15 or fewer physicians) and practices in rural or health professional shortage areas will be impacted and accommodated under CMS’ proposed rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA).

For example, under the proposed rule, clinicians or groups who have less than or equal to $10,000 in Medicare charges AND less than or equal to 100 Medicare patients are excluded from any payment adjustment or penalty under the MACRA Merit Incentive Payment System (MIPS). In addition, if there are insufficient measures and activities applicable and available in any MIPS performance category, then the category would not be included in the MIPS score for that clinician or group (and the weight of other MIPS performance categories would be adjusted to make up the difference in the MIPS score). CMS also is inviting public comment on how solo and small group practices may join “virtual groups” and combine their MIPS reporting; such virtual group reporting would not be implemented until the second payment year, or fiscal year 2020.

MACRA also authorized up to $100 million over five years to provide technical assistance to small practices; on April 13, CMS quietly began the process to issue a request for proposals (RFP) for contractors to provide that technical assistance, but CMS has yet to release any details of the RFP except that the successful technical assistance contractors are expected to begin their work in November 2016.

The fact sheet also references CMS-funded technical assistance already in place through its Transforming Clinical Practice Initiative, which was launched in September 2015, and the ongoing payment reform developmental work being conducted by public and private stakeholders through the Health Care Payment Learning and Action Network.

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