MACRA Rulemaking Takes Center Stage in Washington

James Bush, MD (left) and Mike Tracy, MD visited the state’s congressional delegation last week as part of
The American College of Physician’s Leadership Day. MACRA was a common theme throughout the day.

By Tom Lacock
Wyoming Medical Society

CHEYENNE – Talk to anyone in state or federal government long enough and you will hear them use the acronym, TLAs (or three-letter acronyms) tongue-in-cheek. Physicians around the nation took note of the alphabet soup that is federal healthcare last week as the Medicare Access and CHIP Reauthorization Act of 2015 (aka: MACRA) took center stage.

Recently, The Department of Health and Human Services (HHS) issued a proposal to align and modernize how Medicare payments are tied to the cost and quality of patient care for hundreds of thousands of doctors and other clinicians. According to HHS The Notice of Proposed Rulemaking is a first step in implementing certain provisions of the MACRA. CMS will accept public comment on the rules until June 26. For a fact sheet on MACRA and to submit comments click here. CMS also has a document laying out what MACRA means for small practices, which can be found here.

According to HHS, Medicare currently measures the value and quality of care provided by doctors and other clinicians through a patchwork of programs. Some clinicians are part of Alternative Payment Models such as the Accountable Care Organizations, the Comprehensive Primary Care Initiative, and the Medicare Shared Savings Program—and most participate in programs such as the Physician Quality Reporting System, the Value Modifier Program, and the Medicare Electronic Health Record (EHR) Incentive Program.

Congress streamlined these various programs into a single framework to help clinicians transition from payments based on volume to payments based on value. Today’s proposed rule would implement these changes through the unified framework called the Quality Payment Program, which includes two paths: The Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

With all of the changes, several organizations are offering their tips and efforts to make MACRA more understandable. This week the AMA released a high-level summary of the key provisions of the notice of proposed rule making. The AMA also released its four tips to preparing for the new payment system and a page of MACRA resources. In the release announcing their tips, the AMA points out this is just the beginning of the official rulemaking process, but what is known for sure is that physicians will have a choice in whether to participate in the Merit-based Incentive Payment System (MIPS) or meet requirements for an alternative payment model (APM).

The American Association of Family Physicians is rolling out a large-scale effort to explain MACRA to its members. This week they offered this news release to announce the coming effort, with the major points of the campaign including:  a timeline of important dates; a list of acronyms to help digest the alphabet soup associated with these complicated regulations; a 60-second overview video, a deep-dive review of what value-based payment means to family physicians, and much more.

The American Hospital Association also offered their recommendations on MACRA to US House Ways and Means Health Subcommittee last week. AHA urged the adoption of a MIPS that “measures providers fairly, minimizes unnecessary data collection and reporting burden, focuses on important quality issues and promotes collaboration across the silos of the health care delivery system.” To achieve this, the association said CMS should focus the MIPS measures on national priority areas; allow hospital-based physicians to use their hospital’s performance on quality reporting and pay-for-performance measures in the MIPS; employ risk adjustment rigorously – including sociodemographic adjustment, where appropriate; and align Electronic Health Record Incentive Program changes for physicians with those for eligible hospitals.