Physicians won’t have to start reporting quality under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) until next July at the earliest, if the law’s co-author has his way.
“We’re going to be pushing for at least a six-month delay [in the start date],” U.S. Rep. Phil Roe, MD (R-Tennessee) told Medical Economics in an exclusive interview earlier this week. “In fact, we’ve already asked for that in a letter to [the Centers for Medicare & Medicaid Services (CMS)].” Roe, one of MACRA’s authors, said to Medical Economics while attending the Republican National Convention in Cleveland as a member of Tennessee’s delegation.
Under the proposed rule for implementing MACRA, doctors and practices would have to begin reporting quality data to CMS beginning January 1, 2017. That data will be the basis for rewarding or penalizing doctors in their Medicare reimbursements beginning in 2019. While large healthcare systems likely will be able to meet the January 1 deadline, Roe said, small independent practices will not.
In addition to pushing back the start of the reporting period, Roe says he wants to make the documentation physicians are subject to “easier and simpler.” Asked if that was something Congress can do, Roe says “I think we can, either by influencing CMS or through legislation.”
Before getting elected to Congress in 2008, Roe spent 31 years in private ob/gyn practice in eastern Tennessee. He is part of the 15-member Republican Doctors Caucus in the U.S. House of Representatives. Earlier this year he invited the newly-appointed surgeon general, Vivek Murthy, MD, to meet with caucus members.
“He came in and he said, ‘We’re not going to talk today about what we disagree on, we’re going to talk about what we agree on.’ And we know that one of the great epidemics in this country now is opioid addiction. He agreed with that, and he’s going to come out with a Surgeon General’s report on opioids before he leaves office at the end of the year,” Roe says.
Roe places much of the blame for the epidemic on the widespread adoption of The Joint Commission’s recommendation of treating pain as a fifth vital sign, and the incorporation of pain into patient satisfaction surveys. “By doing that, we’ve encouraged physicians to overprescribe,” he says. “I practiced for 31 years, I did cancer surgery, you name it, and I never wrote a prescription for more than 30 narcotics in my life. We have to re-educate our doctors because of the epidemic we’re experiencing in this country.”
Turning to the subject of rising drug prices, Roe calls it a “good news/bad news situation.” “We want drug companies to flourish, to make capital investments,” he says, citing as an example the development of Harvoni for the treatment of hepatitis C. “We’ve gone from someone needing a liver transplant to now being cured in 12 weeks of a disease that we didn’t even know about when I started in practice,” he says.
The bad news has been the steep price increases for more commonly-used drugs, such as antibiotics. Roe places blame for this trend on the disappearance of many manufacturers of generic drugs, thereby reducing competition. It is a problem Congress can address through increased oversight of the pharmaceutical industry, he says.
Asked what Congress can do to help struggling independent medical practices, Roe cites a bill he wrote at the request of GOP House leadership, the American Health Reform Act. Intended as a replacement for Obamacare, he says the bill would remove much of the paperwork burden facing physicians and “put patients and doctors back in charge” of determining how to pay for medical services.
He adds that the pressures independent practices are facing are not unique to medicine. “Small-town community banks are getting hit. Small-town pharmacies are selling out to the big boxes,” he says. “Small practices are having trouble because they can’t produce enough income to meet all the requirements being put on them.”