MACRA gets checkup from Dr. Congress

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Eight years after becoming law, the Medicare Access and CHIP Reauthorization Act (MACRA) is getting a checkup.

A subcommittee of the U.S. House of Representatives Energy and Commerce Committee is holding hearings on the 2015 law, which replaced the Sustainable Growth Rate formula for determining Medicare payments.

In its place MACRA created the Quality Payment Program, under which physicians can choose one of two ways for Medicare to reimburse them—through the Merit-based Incentive Payment Program (MIPS) or by participating in an Advanced Alternative Payment Models (APM.) By enacting the law Congress hoped to achieve two goals: bring greater stability to Medicare reimbursements, and provide incentives for doctors and practices to adopt payment models tied to quality and care outcomes in place of fee-for-service payments.

In her opening remarks, committee chair Cathy McMorris Rodgers (R-WA) noted that “the traditional Medicare fee-for-service system inadvertently incentivized the proliferation of low-value health care services by paying for volume rather than health outcomes for patients. When seniors visited their doctors, they often received a multitude of services that may not have been necessary for their health, simply because the system rewarded quantity rather than the quality of care.

“Today’s hearing will deepen our understanding of MACRA’s implementation and help us address remaining barriers to optimal patient care,” she added.

In written testimony to the subcommittee Aisha Pittman, senior vice president of the National Association of Accountable Care Organizations (NAACOS), called MACRA “a step in the right direction,” but said “more needs to be done to drive long-term system transformation.” About 90% of advanced payment models are accountable care organizations, or ACOs.

Among NACCOs’ recommendations for encouraging more participation in APMs were to:

• Develop a long-term approach that provides adequate provider payment and provides incentives to participants in APMs, and Advanced APMs
• Better align the incentives between Medicare Advantage (MA) and APMs in traditional Medicare so that APMs can provide comparable benefits to those offered MA patients, such as telehealth visits, transportation benefits, and home visits; and
• Ensure that new payment models developed by the Centers for Medicare and Medicaid Services Innovation Center have a more predictable pathway for being implemented and are not discarded due to overly stringent evaluation criteria.

The Medical Group Management Association, in a letter to the subcommittee chairs, said that despite MACRA’s “positive intent,” its quality component “has proved burdensome and costly due to excessive reporting requirements and inadequate APM participation options.” Among its recommendations were that Congress:

• Reform Medicare Part B to provide annual inflation-based physician payment updates based on the Medicare Economic Index;
• Provide positive financial incentives to support practices transitioning into value-based care; and
• Advance policies that incentivize and reward Part B providers to reduce the total cost-of-care in the Medicare program.