The Senate Finance Committee May 8 held a hearing titled “Medicare Physician Payment Reform After Two Years: Examining MACRA Implementation and the Road Ahead.”
In his opening remarks Chairman Chuck Grassley (R-Iowa) emphasized that the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, P.L. 114-10) is “driving good patient outcomes.” He also stated that MACRA “payment reforms established incentives for physicians to provide the highest quality of care at the lowest possible cost.”
Ranking Member Ron Wyden (D-Ore.) highlighted the need to ensure that smaller and rural practices could also succeed under MACRA, stating that “rural physicians are the backbone of their communities, and they’re relied on for a broad range of care. It’s absolutely essential, as there’s a greater focus on rewarding value in health care, that doctors in small and rural practices aren’t left behind. Otherwise that’ll degrade the care rural patients get, and it’ll cause an even bigger health care gap between big cities and small towns.”
The witnesses largely agreed that, though there is room for improvement in MACRA, that it is still superior to the Sustainable Growth Rate formula, and that alternative payment models (APMs) do hold promise for implementing more value-based care. Barbara L. McAneny, MD, president of the American Medical Association (AMA), stated that they “believe there will be increased opportunities for physicians in various practice group sizes and specialties to participate in Advanced APMs as the Center for Medicare and Medicaid Innovation (CMMI) continues to release new models.”
McAneny qualified her statement, however, by saying that, “The AMA strongly urges Congress to extend the APM bonus for an additional six years to provide physicians a realistic onramp to participation in value-based care. As CMMI continues to test and develop new models, the AMA hopes that physicians will have access to APMs that give them the resources and flexibility to redesign the delivery of patient care and support their efforts to achieve good health outcomes.”
Most witnesses on the panel agreed on the need for Congress to extend the bonus period for APMs.
Other witnesses in the hearing included John Cullen, MD, FAAFP, president of the American Academy of Family Physicians; Frank Opelka, MD, FACS, medical director for quality and health policy at the American College of Surgeons; Scott Hines, MD, director of the American Medical Group Association and Matthew Fiedler, PhD, fellow at the USC-Brookings Schaeffer Initiative For Health Policy.
Members of the panel agreed that Alternative Payment models hold a great deal of promise, and though they may need refinement, they are worth pursuing over MIPS. Fielder stated that policymakers should build on what is working in MACRA and should “discard what is not by increasing the size of MACRA’s incentives for participation in advanced APMs, creating similar incentives for other categories of providers, and eliminating MIPS.”