The 16-member caucus remain concerned about how the law could affect physicians.
All the discussion about whether Congress will repeal and replace the Affordable Care Act has pushed issues surrounding implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 into the background.
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But it turns out the GOP Doctors Caucus is watching the rollout of MACRA carefully and promises to insist on changes if needed.
Caucus Chair U.S. Rep. Phil Roe, MD, (R-Tennessee) says he and his colleagues in the 16-member caucus remain concerned about how the law could affect physicians.
“I believe all options should be on the table to ensure MACRA is implemented in a way that benefits patients and keeps providers-particularly those in small practices-in the Medicare program,” he tells Medical Economics.
Roe has heard from physicians who think the final rule improves on the earlier version of the rule because it allows them not to participate in this first year of its implementation. “But further flexibility for small practices and solo providers would still be welcomed,” he says.
The GOP will monitor the law’s implementation closely and work with the Trump administration to make changes if needed, Roe adds.
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U.S. Rep. Michael Burgess (R-Texas), a physician and caucus member , agrees that the changes the federal Centers for Medicare & Medicaid Services (CMS) made in the final rule will ease some of the challenges physicians will face in complying with the law. “After the release of the proposed rule, members of Congress and the medical community called for increased flexibility for physicians to be reflected in the final rule. I was pleased to see those requested changes made and increased flexibility built in,” Burgess says.
Burgess adds that the final rule, issued in October 2016, addressed the concerns of small, independent and rural practices.
Robert A. Berenson, MD, a fellow at the Urban Institute in Washington, D.C., echoed Burgess’ comments about the effect of MACRA on physicians. An early critic of the law, Berenson now says MACRA should no longer be considered the “death knell” for many small physician practices.
Early last year, Berenson opposed the law’s proposed rule. But now, he says, the revisions CMS made in the law’s final rule make compliance with the law much easier for physicians, especially those in small practices.
Next: CMS did a "good job"
In an interview published in February 2016, Berenson told Medical Economics that MACRA would have forced many small practices out of business or driven them to sell to larger practices or hospitals.
“CMS did a good job of trying to reduce the negative impact of MACRA, at least for the first year,” Berenson explains. “Under the final rule, they are exempting almost 400,000 clinicians from small practices with [Medicare] revenue below $30,000 from having to participate in the first year. That’s very important.”
MACRA contains the Quality Payment Program, which consists of the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). In CMS’s first version of the rule, the MIPS program would have put physicians at too much financial risk, Berenson said. Under the proposed rule, doctors could have lost as much as 9% of Medicare revenue if they didn’t report any data when the law was fully in place in 2019.
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In the final rule, CMS eliminated some of the requirements of MIPS that Berenson considered to be most onerous. Allowing physicians to opt out of the Quality Payment Program in the first year shows that CMS listened to critics of the participation requirements in the proposed rule, he says.
Berenson says giving doctors some additional say regarding MACRA’s implementation not only benefits physician practices, but gives the Trump administration time to consider whether to continue the program in its present form or revise it further.
If MACRA compliance is too difficult, small practices doctors may stop accepting Medicare, Berenson adds.
For this reason, Congress may want to revise the law this year, Berenson says. “MACRA is probably not going to be repealed given how many Republicans and members of the GOP Doctors Caucus voted for it,” he explains. “That would be much too embarrassing. But they can continually try to at least minimize the negative impact of MIPS.”
Roe repeated that all options are on the table and that he and the caucus will work with the Trump Administration if more changes are needed.
Joseph Burns is a journalist in Falmouth, Massachusetts. Do you think Congress needs to revise MACRA? Tell us at firstname.lastname@example.org.