ACC, other medical societies express views on MACRA and new payment models

With the House Energy and Commerce Health Subcommittee meeting on April 19 to discuss payment reforms for physicians, medical societies offered advice on how to implement the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Last spring, the Senate and House of Representatives passed MACRA, a bipartisolation legislation that repealed the sustainable growth rate formula. Under MACRA, physicians treating Medicare patients will have their reimbursement tied to a value-based system. They also now have one quality reporting system.

Richard Chazal, MD, FACC, president of the American College of Cardiology (ACC), released a statement mentioning “it is important that we get it right” with regards to MACRA.

"Since the passage of MACRA, the ACC has been engaged in conversations with the cardiovascular community as well as CMS about the intricacies of implementing this law – and those conversations have been positive and productive,” Chazal said. “As MACRA is implemented, the College encourages CMS to note that quality and value are not one-size-fits all concepts. Therefore, the new payment system must be streamlined and flexible to ensure that the system truly rewards clinicians across all specialties for their efforts to provide evidence-based care and seek innovative ways to manage costs without threatening patient outcomes.”

Barbara McAneny, immediate past chair of the American Medical Association (AMA), appeared before the House Energy and Commerce Health Subcommittee and noted the importance of improving payment models, healthcare delivery and quality reporting. She also mentioned that MACRA must consolidate performance reporting, allow physicians to propose new payment models and account for differences between practices when measuring and comparing practices.

“MACRA makes significant improvements over the current system, including the repeal of the flawed Sustainable Growth Rate formula and giving the Centers for Medicare & Medicaid Services (CMS) an opportunity to reset and improve performance measurement as well as other requirements,” McAneny said. “By increasing the availability of alternative payment models, CMS will spur innovative delivery models focused on enhanced care coordination that can lead to better outcomes for patients.”

Robert M. McLean, MD, FACP, a member of the American College of Physicians’ board of regents, also testified in front of the subcommittee. He recommended that MACRA establish better measures and less burdensome reporting, create realistic pathways for patient-centered medical homes and define eligible alternative payment model requirements.

“I truly believe that MACRA can be a ‘shot in the arm’ to combat burnout, if it is rolled out as Congress intended,” McLean said.

Under MACRA, providers have an update to the fee schedule of 0.5 percent per year from July 2015 through 2019. Beyond 2019, services will be reimbursed at the 2019 level and adjusted based on providers participating in a merit-based incentive payment system or a qualifying alternative payment model. After 2016, providers participating in a qualifying alternative payment model will receive a 0.75 percent update, while other providers will receive a 0.25 percent update.

As of March, an estimated 30 percent of Medicare payments were tied to alternative payment models such as accountable care organizations, according to the Department of Health and Human Services.

“MACRA was designed with very specific goals that responded to years of criticism by stakeholders in how providers are reimbursed, how they interact with the program, the development of new quality measures and means of evaluating and integrating new practice models into the system,” the House Energy and Commerce Health Subcommittee meeting wrote. “At the same time, MACRA was meant to bring much needed transparency into the development and operation of how the Medicare program reimburses providers.”