Physicians tell House panel keys to new Medicare law implementation

Physician leaders Tuesday testified before an influential congressional committee, calling attention to the promise of the landmark Medicare reform law and the necessary steps to ensure implementation is optimal for physicians and patients.

One of the primary goals of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was to repeal the sustainable growth rate (SGR) formula that left physicians in a constant state of uncertainty and threatened patients’ access to care. But the law does a lot more than that.

“The passage of MACRA now allows physicians an opportunity to focus on our patients,” Barbara McAneny, MD, immediate past-chair of the AMA Board of Trustees, told the panel during her opening remarks.

The four physicians spoke at a hearing of the U.S. House Energy and Commerce Committee’s Subcommittee on Health explained that this law provides a path forward, with important improvements over the current Medicare system. These include:

• Eliminating the SGR formula. “This change alone allows more time and resources to be spent focusing on care rather than worrying about how to sustain practices,” Dr. McAneny said in her written testimony. In place of the SGR formula, MACRA established payment updates of 0.5 percent through 2019.
• Streamlining reporting programs. The law enacts a new Merit-based Incentive Payment System (MIPS) that will combine the requirements of the electronic health record meaningful use program, the Physician Quality Reporting System and the Value-based Payment Modifier. “By creating a single reporting program known as MIPS, the law gives us opportunity to streamline measures, reduce reporting burden and create flexibility to encourage physicians in every specialty to participate and improve care,” Dr. McAneny said. MACRA also reduces the stakes for physicians who do not successfully participate in the programs. Under the current system, physicians could face a financial penalty as high as 11 percent in 2019. The new law limits that maximum penalty to 4 percent. And those who meet certain quality benchmarks will receive payment increases. “The law provides strong incentives for physicians to engage in activities to improve quality,” said Robert McLean, MD, of the American College of Physicians’ Board of Regents.
• Promoting physician innovation. Physicians who participate in alternative payment models (APM) will be exempt from the MIPS so they can focus on new ways to coordinate care. Physicians also will receive financial support to participate in APMs, equivalent to 5 percent of their prior year’s aggregate Medicare expenditures. “APMs can be tailored to specific patient populations to drive care improvement, leverage technology and promote new treatments,” Dr. McAneny said. “Importantly, the law acknowledges physician leadership is needed in developing APMs, which not only promotes participation but protects patients and can drive down costs.”

As part of the hearing, each of the physician leaders spoke to the importance of careful implementation of this law under regulations being developed by the Centers for Medicare & Medicaid Services (CMS).

“As the regulations for MIPS and APMs are developed, it is vital that CMS continues to engage the stakeholder community, including provider groups, patient advocates, specialty societies, medical associations, payers and others,” said Jeffrey Bailet, MD, president of Aurora Health Care Medical Group and a member of the new federal advisory committee on physician payment models.

Dr. McAneny pointed to three aspects of implementation that CMS will need to pay careful attention to as it works on regulations coming out of MACRA:

• Consolidating performance reporting. Specifically, the new regulations will need to move away from a pass-fail program design to accommodate the needs of all practices, specialties and patient populations. CMS also will need to improve the timing of feedback reports for physicians. And the agency must minimize unnecessary data collection and the reporting burden.
• Broadening APMs. “MACRA regulations must establish a clear pathway for rapid approval and implementation of physician-focused APMs that establish different approaches to delivering patient care,” Dr. McAneny said. “CMS must avoid adding unnecessary and burdensome requirements to APMs that cause resources to be spent on administrative costs rather than helping patients,” she said. Instead, the agency should provide data and assistance to identify models that are relevant for their practices.
• Improving measurement. Dr. McAneny pointed to such needed improvements as suitable methods for attribution and resource use, elimination of the program flaws that make practices with high-risk patients more susceptible to penalties, and timely data reports.

The physician testifying at the hearing agreed on the great potential of thoughtful MACRA implementation that is based on physician feedback.

“We believe that the work needed to bring about the change in how physicians provide medical care that will make MACRA successful will mean better care for patients, better professional experience for physicians and their medical teams, and better control of health care costs,” said Robert Wergin, MD, board chair of the American Academy of Family Physicians.

CMS’ proposed regulations are expected this spring.