During a House Energy & Commerce Subcommittee on Health hearing on April 19, various physician leaders gave their thoughts on the key elements needed for a smooth transition into the upcoming Medicare Access and CHIP Reauthorization Act (MACRA).
The subcommittee heard from Patrick Conway, M.D., deputy administrator for innovation and quality at the Centers for Medicare and Medicaid Services (CMS), last month, during a hearing that focused largely on current capabilities of the industry to measure value and outcomes in the fashion that will be necessary for participation in Merit-based Incentive Payment System (MIPS) or an alternative payment model (APM). During that hearing, Conway alluded to forthcoming coming flexibility under the meaningful use program, which becomes one of four performance categories for those physicians participating in MIPS. Beginning in 2019, payment adjustments will begin for physicians as they choose between the new MIPS or participate in a qualifying APM. But, those adjustments will be based on previously reported data starting in 2017.
It has been a year after the MACRA bill was signed into law, but as reported by Healthcare Informatics in one of its Top Ten Tech Trends of 2016, physician leaders find themselves in quite the precarious position, as even as the first program year of the law is scheduled to start in less than 12 months, there is little awareness about the health IT provisions of MACRA amongst the provider community. The White House’s Office of Management and Budget (OMB) is currently reviewing a proposed rule that it got last month that will implement MACRA, and industry insiders estimate that for a rule this size, publication should be expected later this spring. The final rule is expected to be completed this fall.
On Tuesday April 19, the Subcommittee on Health held its second hearing on MACRA, with several physicians present to give witness statements and answer questions, including: Jeffery W. Bailet M.D., executive vice president Aurora Health Care, co-president Aurora Health Care Medical Group; Barbara L. McAneny, M.D., on behalf of the American Medical Association (AMA); Robert McLean, M.D., on behalf of American College of Physicians (ACP); and Robert Wergin, M.D., board chair, American Academy of Family Physicians (AAFP).
Congressman Joe Pitts (R-PA) chairs the Subcommittee on Health and opened the hearing by advising physicians to participate in current value-based programs to act as springboard for MACRA. He said they should also start evaluating options available to them regarding whether MIPS or an APM is right for them for the future of their practice. Congressman Gene Green (D-TX) added that the physician stakeholder community has provided extensive feedback regarding the legislation and is continuing to work with this subcommittee and with CMS to make sure this legislation works, noting that Congress’ intent is for quality measures to be tailored to specific specialties.
Meanwhile, Congressman Michael Burgess (R-TX) said that MACRA, with the repeal of the Sustainable Growth Rate (SGR) formula, signals a five-year cessation of hostilities between Congress, federal agencies, and physicians. “We need to make certain that we get it right and put the power back in the hands of those who provide care so that doctors, not agencies, will help shape the programs of the future,” Burgess said.
Docs Continue to Wait
Broadly, the AMA, ACP and AAFP all expressed support for MACRA in their witness statements, referencing the broken system of reimbursement patches under the SGR formula, and the need to align and simplify quality reporting programs. “The legislation will truly reward those who have made investments or evolved into advanced practice structures like patient-centered medical homes (PCMHs) or other alternative delivery models where data and clinical metrics are used to improve population health and healthcare delivery,” according to an ACP statement given by McLean.
That being said, there is a burning desire among the physician community to know more about the law and also ensure that successful implementation of MACRA does indeed occur. According to AMA, success will be the result of CMS requiring rulemaking that will constructively 1) consolidate performance reporting; 2) broaden participation in APMs; and 3) improve measurement to reflect differences across medical practices. ACP also noted a fourth necessity—reducing physician burnout. “Hence the Triple Aim is now becoming the ‘Quadruple Aim’ with a fourth goal of ‘improving the work life of healthcare clinicians and their staff,’” according to an ACP statement. AMA’s McAneny added, “People know that MACRA is there but not how it will apply to them yet.”
ACP’s McLean additionally noted that MACRA gives physicians more individual control over Medicare pay, since it is based on quality. He said, regarding MACRA, he is most excited about the idea that physicians can take a lot of data floating around and make it actionable and incentivized. “There is also a lot out there on clinical guidelines and measures, so how do we use them? Those [elements], if they can be put into a situation where physicians can be incentivized to use this data well, then we can make that a part of our daily flow leading to better, safer, and more reliable care, and happier doctors since they won’t be checking boxes just because CMS told them too,” McLean said.