The House Energy and Commerce Committee July 26 held a hearing on the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, which replaced the Medicare physician payment system with a new, quality based system. The hearing was twice rescheduled so that providers could benefit from and make any changes in their assessment of the new payment system based on their experience with newly released data from CMS on individual provider performance data in the new quality system. The hearing is one of a series focused on how to improve MACRA as it is implemented.
In his opening statement, Health Subcommittee Chair Michael Burgess, MD (R-Tex.) stated “MACRA changed the world of Medicare provider payments as we knew it. It has laid the groundwork for increased access to quality care for beneficiaries by eliminating the uncertainty of the past, reducing physician burden, and providing incentives where there were none. MACRA was never a law that was going to be fully implemented with the flip of a switch, it was designed as a long term effort to move the Medicare program down the value continuum.”
Ranking Member Gene Green (D-Tex.) also discussed the importance of MACRA as an alternative to the previous Medicare physician payment system - known as the "sustainable growth rate" (SGR) - in his opening statement, “…SGR was a thorn in the side of Medicare and doctors who treated Medicare patients for over a decade after it was created in 1997…MACRA did more than just repeal the flawed SGR formula – it was designed to overhaul and realign payment incentives for Medicare and transition our healthcare system to one that rewards value instead of just the volume of care.”
Witnesses at the hearing included David Barbe, MD, MHA, Immediate Past President, American Medical Association; Frank G. Opelka, MD, FACS, Medical Director, Quality & Health Policy, American College of Surgeons; Parag Parekh, MD, Chair, Government Relations Committee, American Society of Cataract and Refractive Surgery; Ashok Rai, MD, President & CEO, Prevea Health, Chairman of the Board, American Medical Group Association; and Kurt Ransohoff, CEO, Sansun Clinic, Chairman of the Board, America’s Physicians Groups.
All witnesses agreed that MACRA is preferable to the repealed SGR; however, witnesses suggested several improvements that could be made moving forward. For example, in his opening statement, Dr. Barbe suggested, “…(T)here are further changes to the program that would reduce physicians’ administrative burden, including reducing the number of quality measures a physician is required to report within the Quality performance category and allowing physicians the option to report for a minimum of 90-days in all performance categories to better align reporting periods.”
Dr. Opelka also recommended that quality measures must be adjusted, “Surgeons support being held accountable for the quality of care received by their patients. It is, however, essential that efforts to do so are accurately measuring quality in a way that can lead to improvement and which does not overburden providers, inadvertently taking their focus away from the patient. To accomplish this, CMS needs measures that accurately and meaningfully target the episode of care being assessed, providing useful information to physicians and patients. This is not currently the case.”
Several witnesses also recommended that more clinicians should be subject to the Merit-based Incentive Payment System (MIPS). In his opening statement, Dr. Rai stated, “If Medicare providers are going to successfully transition to value-based arrangements, more of them should be subject to MIPS. I realize that some providers may lack the resources to participate in these programs, but as mentioned above, this transition has been a work in progress for years. In addition, CMS provides technical support and favorable scoring for some providers. Our patient population deserves a provider workforce that is willing and capable of providing the best level of care possible. These MIPS exclusions do not prepare practices of any size to transition to a post fee-for-service payment environment and unfairly penalize those who have worked in good faith to make that transition.”
MIPS is one of the models of quality measurement physicians can opt to comply with under the requirements of the new MACRA payment system. It will be fully implemented on January 1, 2019. Additional hearings on MACRA or MIPS have not yet been scheduled.