Improving MACRA implementation

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6/11/2019

On May 8, the Senate Finance Committee held a hearing on implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) and relevant Medicare payment policies. In written testimony, MGMA highlighted the Association’s advocacy priorities related to MACRA and its two payment pathways: The Merit-based Incentive Payment System (MIPS) and alternative payment models (APMs). While supporting MACRA’s overall framework, MGMA offered several recommendations aimed at improving MACRA, including the following:

Continue policies that stabilize Medicare physician payment

MACRA stabilized annual updates under the Physician Fee Schedule (PFS) and is a vast improvement to the previous, draconian sustainable growth rate methodology. Under MACRA, PFS payment updates increased by 0.5% each year between 2015 and 2018 and 0.25% in 2019 but will be frozen for six years between 2020 and 2025.

Even with the MACRA updates, Medicare physician reimbursement updates have been relatively flat. On top of this, physician practices face a challenging environment with escalating costs and an increasingly complex regulatory environment. According to the 2019 Medicare Trustees Report, under current policy, Medicare physician payments are not expected to keep pace with the average rate of physician cost increases.1 To provide group practices with stable, sustainable Medicare reimbursement, MGMA urges Congress to continue the stability in physician payments by extending the 0.5% annual positive payment update beyond CY 2019.

Encourage the development and availability of physician-focused APMs

MGMA has long supported Congress’ work to support physician practices as they transition to value-based payment models by providing incentives to participate in APMs, including a 5% bonus payment for significant participation in APMs. This 5% bonus is a powerful incentive for practices to participate in APMs, but it is set to end in 2024.

To increase opportunities to participate in voluntary APMs, MGMA reiterates its long-standing ask that Congress encourage the creation of additional APMs. The Association also urges Congress to extend the availability of the APM incentive payment past 2024.

Streamline and simplify MIPS reporting requirements

As medical group practices transition to value-based payment to improve the delivery of healthcare, they are hamstrung by burdensome and outdated government mandates that impede innovation, drive up costs and ultimately redirect resources away from patients.

MGMA urges Congress to exercise greater oversight authority to ensure the Centers for Medicare & Medicaid Services (CMS) does more to streamline and significantly simplify reporting requirements and scoring policies under MIPS. This includes reducing the overall number of measures required for full participation in MIPS, using a flexible set of measures, improving calculation of MIPS cost measures and providing more meaningful and frequent feedback on performance.

The federal healthcare policy landscape is evolving at a rapid pace, and MGMA’s Government Affairs office in Washington is working directly with Congress and the Administration to support the interests of medical group practices. Moving forward, the Association will continue to engage policymakers regarding MACRA implementation and additional Medicare physician payment reforms.

Note:

CMS. 2019 Annual Report of the Board of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. April 22, 2019. Available from: go.cms.gov/2KZdxIP.