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Congressmen Push Feds to “Consider Flexibilities” for MACRA

September 8, 2016
by Rajiv Leventhal
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Leaders of the U.S. House Energy and Commerce and Ways and Means committees have written a letter to the U.S. Department of Health and Human Services (HHS), urging federal leaders to consider certain flexibilities for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

The bipartisan group of congressmen, including Committee on Energy and Commerce Chairman Fred Upton (R-MI) and Committee on Ways and Means Chairman Kevin Brady (R-TX), stopped short of asking the Centers for Medicare & Medicaid Services (CMS) for a delay to the scheduled Jan. 1, 2017 start date, but did urge the administration to “consider flexibilities for all practices, including small practices,” so they can succeed under the new law.

The letter to HHS Secretary Sylvia Mathews Burwell says that while MACRA requires significant changes in physician payment to move from volume to value, “we believe that many of the nation’s physicians are ready for these changes as they incorporate the physician payment and quality predecessor programs, which have been in existence for many years.” This is particularly interesting, as a Deloitte Center for Health Solutions survey in July revealed that half of responding physicians said they have never even heard of MACRA.

The Congressmen do call for certain flexibilities from CMS, however, including: simplified, streamlined, and coordinated requirements; clear pathways to succeed in MACRA’s two payment tracks (the Merit-Based Incentive Payment System and the Alternative Payment Models); opportunities to move to the APM track and flexibilities to be rewarded for meaningful delivery system reform activities in both tracks; and reporting in January 2017 when appropriate systems are ready in place.

Most health IT policy experts predict that a MACRA final rule will be published no later than Nov. 1, though even that date would give providers very little time to review the rule and get ready for the start of the reporting period just a few months later.

The letter concluded, “We understand the timeframe is short, but we are committed to a successful and timely implementation of the law while still providing practitioners time and opportunity to succeed.” What’s unclear is if the Congressmen actually prefer a delay or if they want the reporting period to begin as scheduled with certain simplicities granted.

Talk of a delay to MACRA is not new. During a July 13 U.S. Senate Committee on Finance hearing on MACRA, CMS Acting Administrator Andy Slavitt left open the possibility that the new sweeping changes set to overhaul physician payment could be pushed back from the intended start date of Jan. 1. During that hearing, Congressman Orrin Hatch (R-UT) stated that the MACRA law gives CMS the flexibility to move the start date of the reporting period back.

“Physicians are concerned about the timeline. If CMS releases the final rules around Nov. 1, that only leaves two months for them to prepare. It’s a legit concern,” the Utah senator said. Slavitt agreed with Hatch, responding that the program needs to be launched “so it begins on the right foot, so every physician in the country feels that they are set up for success.” He added, “There has been significant feedback received here, and we remain open to options including alternative start dates, looking at shorter [reporting] periods used, and other ways physicians could get help and experience before the program hits them.”

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