May 13, 2016

ays and Means Health Subcommittee Holds Hearing on MACRA Implementation

At a May 19 House Ways and Means Health Subcommittee hearing, both Republicans and Democrats largely applauded efforts by Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services (CMS), to implement the Medicare Access and CHIP Reauthorization Act (MACRA). Slavitt’s testimony marked his first appearance before Congress following the public release of a massive, 900-page proposed rule to implement MACRA.

Enacted with strong bipartisan support in April 2015, MACRA replaced the flawed Sustainable Growth Rate (SGR) formula with a policy that reimburses physicians based on the value of care they provide patients rather than number of procedures administered to an individual. More specifically, starting in 2019, physicians who accept Medicare patients will have the choice of participating in either the Merit-based Incentive Payment System (MIPS) or Alternative Payment Models (APM). The MIPS is essentially a modified fee-for-service system with more relatively stringent quality assurance and measurement standards, while APMs are innovative care models, such as Accountable Care Organizations (ACO), that hold providers responsible for the quality and cost of the care they deliver to a population of patients.

Prior to MACRA’s passage, CMS administered a variety of disparate quality measurement policies, specifically the Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VBM) and Electronic Health Record (EHR) “meaningful use” program. Physicians routinely complained that these programs failed to positively impact patient care and placed an unduly heavy reporting burden on practices.

MIPS, however, streamlines and consolidates the PQRS, VBM and EHR “meaningful use” policies, as well as newly created clinical practice improvement activities (CPIA), into a single larger reimbursement program. The extent to which physicians successfully meet all the requirements outlined in these previously separate programs will now be captured in a single “composite score.” Physicians’ composite scores compared to annual benchmarks will determine whether they should be subjected to payment penalties or qualify for reimbursement bonuses.

Slavitt informed the Ways and Means Health Subcommittee that CMS conducted extensive public outreach prior to releasing the proposed MACRA regulation. In fact, the agency listened to over 6,000 health care stakeholders, such as state medical societies, national physician organizations, including the American College of Radiology, consumer groups and federal partners.

This extensive public input prompted CMS to follow three themes when formulating the proposed rule. First, CMS worked to ensure that patients were the regulation’s primary focus. In addition, the agency sought to create a flexible quality measurement component that reflected the needs of a diverse range of patient populations and practice types. Finally, CMS attempted to issue a regulation that simplifies the care delivery system.

Fueled by CMS data published in the proposed rule indicating that 80 percent of practices with nine or fewer providers could endure some form of payment reduction under MACRA, the vast majority of Republican and Democratic Subcommittee members questioned Slavitt about the regulation’s impact on small and rural practices. In response, Slavitt clarified that the chart in question is largely obsolete because it reflects 2014 data.

Slavitt also assured federal lawmakers that small and rural practices have an equal opportunity to succeed in the MIPS or APM policies in comparison to larger, urban facilities.

Rep. Tom Price, MD (R-GA) asked a series of pointed questions focused on APMs and the revisions to the EHR “meaningful use” program. Price pressured Slavitt to use the pending comment period to revise the regulation in a manner that ensures more than six existing innovative care models can qualify as APMs. The congressman also urged the agency to shorten the EHR reporting period from a full calendar year to 90 days. Slavitt stressed that the APM and EHR sections are fully open for public review and comment.

The Ways and Means Committee is expected to hold additional MACRA oversight hearings in the near future. ACR members are encouraged to monitor the Advocacy in Action e-newsletter for the latest on Congress’s ongoing efforts to review the MACRA implementation effort.