There is considerable uncertainty in the federal healthcare policy arena right now, with a new president and administration, and the new president’s Health and Human Services Secretary-designate not yet confirmed by the U.S. Senate. What’s more, Rep. Tom Price, the Georgia Republican whom President Trump has chosen to lead HHS, is both a former practicing physician (he practiced orthopedic surgery in the Atlanta area for over 20 years), has been one of the most active members of the House of Representatives in terms of healthcare legislation and regulation in the two years he has served in the House, as a fiery opponent of the Affordable Care Act (ACA) and of what he has called excessive healthcare regulation.
What might happen in the next two years in terms of federal healthcare legislation and regulation, as well as the current complexities around quality reporting requirements under the MIPS (Merit-based Incentive Payment Program) and under the APMs (alternative payment models) framed by the MACRA (Medicare Access and CHIP Reauthorization Act of 2015), will be the subject of a presentation at the MGMA 2017 Financial Management and Payer Contracting Conference, sponsored by the Englewood, Colo.-based Medical Group Management Association (MGMA), and held Feb. 19-21 in Las Vegas. On Monday morning, Feb. 20, Jennifer McLaughlin, senior associate director for governmental affairs at MGMA, will present on the topic of “The Evolving Medicare Payment Landscape.” As the conference’s program description explains it, “With implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) underway, physician practices are assessing the two new pathways for Medicare payment—traditional fee-for-service coupled with a quality performance bonus or penalty under the new Merit-Based Incentive Payment System (MIPS) and risk-based alternative payment models (APMs). This timely session will review the key details of MIPS – which replaces PQRS, meaningful use and the Value-Based Payment Modifier – and APMs.”
Recently, the Washington, D.C.-based McLaughlin spoke with Healthcare Informatics Editor-in-Chief Mark Hagland about the present moment in federal healthcare policy, and how she and her fellow advocacy leaders at MGMA, which represents 350,000 physicians practicing in 18,000 patient care organizations, see the policy challenges and opportunities going forward for their association’s member medical groups. Below are excerpts from that interview.
What are you basically going to be talking about in your presentation at this month’s upcoming conference, in terms of policy and payment?
I’m really going to be a drilling down on some of the questions around MIPS and MACRA, and addressing some of the questions that our members should be considering. And acknowledging that most participants will be in MIPS at the beginning, we will look at all the different MIPS quality scores and drill down, and look at some of the APMs on the table that practices need to know. And I’ll start by looking at the broader landscape around value-based care delivery and payment that’s not going away. And there may be some changes with the new administration, and will provide some perspectives on that.
So essentially, you believe that MACRA and MIPS will largely be left alone by the new Congress?
It’s hard to know without a crystal ball whether any of these programs might be impacted by any broader policy changes? But I agree, MACRA was bipartisan and separate from the ACA. And this move towards value-based payment has been going along for a long time, and I don’t see them being changed on a broad level. Largely, where we see some issues will be on the APM side, in terms of the risk definitions, and definitions of qualitied participant organizations.
Do you see any wholesale changes to MIPS being made?
Anything is on the table, given Rep. Price’s role and leadership in enacting MACRA. His intimate knowledge of the program increases the chances that we may see some wholesale changes. Last year, we were asked to present a number of changes prior to the final legislation. Price was there at the meeting at the beginning of October of what’s called the “Doctors’ Caucus”—an informal group of about 18 to 20 members of the House who are physicians. They invited a number of medical associations and physician specialty groups regarding physicians’ concerns about MACRA. This was just before the final rule came out on October 14. So this was at the beginning of October. And Rep. Price was fully engaged in overseeing the policy, and even in the weeds at that moment. So he comes in with an unprecedented understanding of how this law is being implemented; so really, anything is on the table.
But they wouldn’t overturn MACRA, because they’d have to put that SGR money back?
That’s right. And any changes that might be made to MACRA/MIPS would probably go into effect in 2018 and in subsequent years, not this year.
So, to be clear, you don't believe that MACRA will be overturned by Congress?
Is it a possibility that the number and rigor of MIPS quality measures might be drawn down?