May 09, 2019

Senate Finance Committee Assesses Status of MACRA Implementation

The Senate Finance Committee gained a comprehensive view of the strengths, weaknesses and opportunities for improving Medicare Access and Chip Reauthorization Act (MACRA) implementation May 8 in testimony from representatives of four major medical societies and invited health care policy experts at a hearing entitled, “Medicare Physician Payment Reform After Two Years: Examining MACRA Implementation and the Road Ahead.”

Lawmakers heard testimony from representatives from a range of stakeholder organizations, including: Barbara L. McAneny, MD, of the American Medical Association (AMA), John S. Collen, MD, of the American Academy of Family Physicians (AAFP), Frank G. Opelka, MD, FACS, of the American College of Surgeons (ACS), Scott Hines, MD, of the American Medical Group Association (AMGA) and Matthew Fiedler, Ph.D., of USC-Brookings Schaeffer Initiative for Health Policy Economic Studies.

During their opening remarks, committee leadership recalled the broad bipartisan efforts that culminated in repeal of Medicare’s flawed sustainable growth rate (SGR) policy and agreed that continued oversight will be necessary to ensure that the new payment program works for providers in all practice settings.

Among the witnesses, there remains general agreement that additional work is needed to achieve MACRA’s vision of a payment system based on the quality and effectiveness of clinical care. While panelists reiterated support for SGR’s repeal, they also outlined various concerns and/or areas for improvement for MACRA. Highlights from the witness testimony include:

  • McAneny of the AMA outlined the association’s concern that the 2019 Medicare Trustees Report found that scheduled physician payment amounts are not expected to keep pace with the average rate of physician cost increases. As such, the AMA is urging Congress to replace the upcoming physician payment freeze with annual positive payment updates over the next several years to provide physicians with a stable and sustainable revenue source that will foster investment in practice improvements to aid in the transition to more efficient models of care delivery. 
  • Cullen of the AAFP urged lawmakers to take action on the following points: correcting the undervaluation of fee-for-service payment for primary care, reducing the complexity in MIPS scoring, eliminating the Merit-based Incentive Payment System (MIPS) Alternative Payment Model (APM) category, extending the Advanced APM bonus and creating a culture focused on patient care.
  • Opelka of the ACS noted that despite good intentions, many aspects of MACRA implementation are not working. Although ACS appreciates MACRA’s focus on quality, they are concerned that it has come at a cost to other priorities. Moving forward, ACS hopes to promote a collaboration with CMS that would include defining the patient-centered care model, identifying the structure and processes and assign quality metrics and attaching an incentive payment program to achieve care goals.
  • Hines of AMGA outlined efforts by his member to invest time and resources into delivering the best possible care while still focusing on improving value and outcomes. However, he argued that since 2017, the first performance year for MIPS, we have taken a step back from the natural transition to value-based care due to the exclusion of half of eligible clinicians from MIPS and enforcing arbitrary threshold requirements for Advanced APMS.
  • Fiedler of USC Schaeffer testified that MIPS is unlikely to improve the quality or efficiency of patient care in his opinion. It is creating administrative costs. MACRA’s bonus payments for clinicians participating in advanced APMs have great potential to increase participation in these models. Policymakers should build on what is working in MACRA and discard what is falling short of expectations by increasing the size of MACRA’s incentives for participation in advanced APMs. In addition to broader changes, Fiedler noted that are several narrow fixes that could be implemented, though he also recommended the complete elimination of the MIPS program.

Moving forward, the American College of Radiology will continue to engage Congress and the Trump Administration regarding MACRA’s implementation and the potential for additional Medicare physician payment reforms. The full witness testimony and a playback of the hearing is available on the Senate Finance Committee website.