Reducing the Burden for Rural and Small Healthcare Providers under MACRA

MACRA Releases New Rules for Rural Practices

As the end of June approaches, the Centers for Medicare and Medicaid Services (CMS) announced their updated ruling on requirements for rural and small healthcare practices participating in MACRA.  This month’s ruling is reducing the burden on these practices who treat a smaller number of Medicare patients and have a lower threshold for purchasing new software packages.  In all, the proposed bill is a total of 1,058 pages in length.  To come up with this and other effective rulings, CMS has interviewed and engaged over 100 stakeholders and 47,000 individuals.  

The changes in this new bill will take effect in 2018, which is the second year of the MACRA Legislation, and the first year of mandatory participation.  CMS has heard the fears of small practices that this new legislation will require too many forms, new software tools, and regulations that will take the focus off of the patient, and their well being, forcing practices to focus on compliance instead.  So they set off on a mission to simplify participation in the Quality Payment Programs with this new Rule.


According to the Quality Payment Program Fact sheet, published by CMS, the goal is to:

  1. Improve Health Outcomes
  2. Spend program funds wisely
  3. Minimize the burden placed on participating practices
  4. Provide transparency and fairness


Within the Quality Payment Program, there are two possible tracks available to a practice:


  1. The Merit-Based Incentive Program or MIPS


  2. Advanced Alternative Payment Models or Advanced APMS


Changes for Year 1 of MACRA or 2017 that are being expanded upon in this new ruling:


  1. Clinicians now have options of how much data they report – either 90 days worth of data or the full year.

  2. Created a low volume threshold, that exempts clinicians who treat a low volume of Medicare Part B patients. (less than $30,000 in Part B allowed charges OR ≤100 Part B beneficiaries.)

  3. Non Patient Facing: Created flexibilities for clinicians who are considered to be a part of a hospital or who do not have much engagement with their patients. (Less than 100 patient encounters)
  4. Submission Mechanisms: MIPS clinicians are required to use only one submission mechanism per category


In the second year of MACRA or 2018:


  1. The Low Volume Threshold: Increased to less than $90,000 in Part B allowed charges or less than 200 Part B beneficiaries.

  2. Non Patient Facing: Creating what are being called Virtual Groups.  Virtual Groups with less than 75% Non Patient Interactions.  Virtual groups are comprised of individual practitioners, and/or groups of 10 or less individual practitioners who come together with at least one other individual or group for a 1 year performance period.

  3. Submission Mechanisms: MIPS clinicians will have multiple options for the submission of information.

Please visit the CMS Fact Sheet. or more information, and numbers regarding performance in:

  • Quality score measurement
  • Cost score measure
  • Improvement activities
  • Complex Patient Bonus
  • Small Practice Bonus
  • Performance Thresholds and Payment Adjustments
  • And More


This new ruling is open for comments until the date of August 18th, when it will be officially implemented.