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September 13, 2016



CMS to Provide Flexibility on MACRA Requirements

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CMS to Provide Flexibility on MACRA Requirements

On September 8, the Centers for Medicare & Medicaid Services (CMS) announced new flexibility in the implementation of Medicare’s Quality Payment Program, which was required by the Medicare Access and CHIP Reauthorization Act (MACRA) and replaces the Sustainable Growth Rate (SGR) formula. In a CMS blog post, Acting Administrator Andy Slavitt laid out four options for reporting data under the Quality Payment Program.

  1. First Option: Test the Quality Payment Program. According to CMS, with this option, as long as physicians submit “some data,” including data from after January 1, 2017, physicians will avoid a negative payment adjustment.
  2. Second Option: Participate for part of the calendar year. Physicians may choose to submit Quality Payment Program information for a reduced number of days, allowing the first performance period to begin later than January 1, 2017 while still qualifying physicians for a small positive payment adjustment.
  3. Third Option: Participate for the full calendar year. For practices that are ready to go on January 1, 2017 and submit Quality Payment Program information for a full calendar year, physicians could qualify for a modest positive payment adjustment.
  4. Fourth Option: Participate in an Advanced Alternative Payment Model in 2017.

This announcement comes after intense pressure from numerous physician groups – including the American Association of Orthopaedic Surgeons (AAOS) – that urged for greater flexibility in the implementation timeline. In its comment letter to CMS, AAOS explained that it would be “burdensome, if not impossible, for physicians to get ready for the first performance year of 2017” and that “physicians who find this time frame too difficult to comply with may not participate in the MIPS program at all.”

CMS referenced the physician feedback and commented that they also heard from physicians and other clinicians on “how technology can help with patient care and how excessive reporting can distract from patient care; how new programs like medical homes can be encouraged; and the unique issues facing small and rural non-hospital-based physicians.” According to Slavitt, CMS will address these areas and “the many other comments we received” when the agency releases the final rule by November 1, 2016.

“In recognition of the wide diversity of physician practices, we intend for the Quality Payment Program to allow physicians to pick their pace of participation for the first performance period that begins January 1, 2017,” wrote Slavitt. “However, you choose to participate in 2017, we will have resources available to assist you and walk you through what needs to be done. And however you choose to participate, your feedback will be invaluable to building this program for the long term to achieve outcomes that matter to your patients.”

AAOS thanks Secretary Burwell and Acting Administrator Slavitt for their work to address concerns related to MACRA implementation. Still, as Slavitt noted in the CMS blog post, there are additional issues that must be addressed and AAOS looks forward to examining the final rule this fall.

Read the full AAOS comment letter online here.

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