Radiologists and other physicians reject proposal to consolidate MAC jurisdictions

Radiologists and other physicians are rejecting a proposal to consolidate Medicare Administrative Contractor jurisdictions while also extending the duration of MAC contracts. 

The Centers for Medicare & Medicaid Services first sent out its request for information in September, mulling the possibility of reducing four MAC districts down to two. In addition, CMS also is considering extending MAC contracts from 7 to 10 years amid a period of stability in the program. 

Physician groups such as the American Medical Association and American College of Radiology recently weighed in, sharing their opposition to the idea. ACR believes reducing the number of MACs will have a negative impact on the field, making it harder for physicians to interact with contractors. 

“Based on the ACR’s experience with MACs over the last few years, we are concerned that consolidation of MACs will lead to further communication challenges between the physician community and the MACs,” CEO Dana H. Smetherman, MD, MBA, wrote in comments submitted Oct. 4. “Larger jurisdiction size is likely to lead to fewer [Contractor Medical Directors] per capita or, at a minimum, decreased CMD availability. This presents several challenges for the MAC, as well as patients and physicians in the new larger jurisdiction.” 

Under the proposal, CMS would combine J5 and J6 into a single “Jurisdiction G” and J8 and J15 into a single “Jurisdiction Q.” Doing so could produce benefits such as economies of scale while saving the Medicare program money. However, doc groups are more focused on the downsides. CMS had previously tried to consolidate MAC jurisdictions in the early 2000s but paused the effort in 2014 “in the interest of promoting long-term program stability by building a competitive pool of contractors.”

The agency is not detailing why its reviving the effort, AMA noted, nor why it selected these four MAC jurisdictions for consolidation. “Notably,” two MACs—WPS and CGS Administrators—would have all their jurisdictions subject to consolidation. But the agency isn’t providing insight into plans for reassigning these jurisdictions, whether it would be to one of the two MAC, or how workloads would be redistributed. 

“CMS needs to provide justification and data supporting these changes and the benefit they would bring to Medicare beneficiaries and physicians followed by another feedback opportunity,” AMA CEO James L. Madara, MD, wrote in comments submitted Oct. 3. 

The American College of Physicians echoed these concerns in its own comments, noting that the consolidation process could burden physicians and negatively impact patient care. Installing a new MAC would create additional processed for enrollment, claims review and appeals, with clear implications for clinical staffing. ACP “strongly” urged CMS to provide details about plans to increase support during this process. 

“The MAC operating in this jurisdiction will have a higher share of claims and need adequate staffing to meet the demand. CMS must ensure there is an increase in staffing and training in the subject jurisdiction to ensure patient care is not disrupted,” the American College of Physicians wrote Oct. 4. “Each MAC also operates differently, and inconsistencies and a lack of transparency can be confusing and burdensome for physicians. The college urges CMS to establish a consistent approach for MACs when requesting records, conducting a physician review, and denying claims.” 

The American College of Radiology promoted its comments in a new updated posted Wednesday. You can read its full message here.