Representatives of the American Medical Association, Trinity Health, and Blue Cross Blue Shield are pressing for a postponement to the proposed Medicare Access and CHIP Reauthorization Act rule. From MedPage Today.
This article first appeared July 13, 2016 on the MedPage Today website.
by Shannon Firth
Physician and other major healthcare groups continue to lobby the Centers for Medicare and Medicaid Services (CMS) to delay the start of the new rule that overhauls physician payment.
Representatives of the American Medical Association (AMA), Trinity Health, and Blue Cross Blue Shield (BCBS) pressed for a postponement to the proposed Medicare Access and CHIP Reauthorization Act (MACRA) rule at a panel Monday hosted by the Alliance for Health Reform, and sponsored by the AMA and the BCBS Association.
The reporting period for the new rule is slated to begin in January 2017, with payments adjustments based on those metrics to begin in January 2019.
One panel member, Thomas Eppes, Jr, MD, of Central Virginia Family Physicians, in Lynchburg, Va., and chair of the AMA Integrated Physician Practice Section Governing Council, described the new rule as a "quantum shift" for physicians that creates too much administrative burden.
Eppes also said that the window for trying to understand and meet the requirements of the MACRA rule is too short. The AMA has recommended delaying the start of the performance period from January to July 2017.
"Do it right. Do it right the first time," he said.
MACRA consists of two payment channels: the Merit-based Incentive Payment System (MIPS) and a system of advanced alternative payment models (APMs) that beginning in 2020, will receive a 5% bonus delivered in a lump sum each year.
Most physicians will not be eligible for the advanced APMs and will be relegated to MIPS, which relies on a four-part scoring model based on metrics of quality, resource use, advanced care information, and clinical practice improvement activities.
In addition to delaying the rule, Eppes and the AMA urged CMS to:
- Further simplify the reporting requirements for quality and clinical practice improvement
- Increase the low-volume threshold to exempt more physicians from the default payment program (MIPS)
- Preserve the "hardship exemption" offered under Meaningful Use for its replacement, Advance Care Information
"You make it too complicated, you're going to lose physicians," he said. "They'll either quit [or] they'll quit taking Medicare and Medicaid. They will opt out. ... They'll do concierge. That's not what you want."
Tonya Wells, vice president of public policy and federal advocacy for Trinity Health in Livonia, Mich., also pushed to reset the start date of the performance year to January 2018. She also recommended pushing the first MIPS and advanced APM payment year from 2019 to 2020.
BCBS has recommended a "soft launch" of the MIPS program, said Donald Fischer, MD, MBA, of DRFischer Consulting in Pittsburgh, who recently retired as chief medical officer for BCBS's western Pennsylvania affiliate. He said the insurer would prefer either delaying the start date for the performance period or "staggering start dates."
Panel member Lemeneh Tefera, MD, medical officer for the Center for Clinical Standards & Quality at CMS, stressed that the rule's start date of January 2017 was only "the beginning of a window to report" and that some metrics could be reported as late as March or July 2017.
Joel Brill, MD, chief medical officer at Predictive Health in Phoenix, and a representative of the American Gastroenterological Association, criticized CMS for favoring primary care over specialty groups.
Brill, who was not on the panel, said he wanted to know why CMS wasn't including more disease-specific models in their advanced alternative payment models. Among the six proposed models that currently qualify as advanced APMs, only one, the Oncology Care Model Two-sided Risk Arrangement, targets specialists.
One model in the Predictive Health system showed a 50% reduction in emergency department visits and inpatient hospitalizations, Brill said, and also shrunk overall annualized costs for children and adults with irritable bowel syndrome.
"If we are demonstrating what you're asking for -- upside and downside risk, decrease in unnecessary care, improvements in patient engagement, and overall decrease in cost -- what else do you want from us for an APM?" he said.
Tefera directed Brill to the physician-focused payment advisory committee (P-TAC), the channel through which alternative payment models can be vetted for possible consideration to the CMS.
"A lot of the work we're doing is incremental," he stressed. "We have not reached as many corners in the house of medicine as we'd like to but we are working to do that."
However, not everyone was in favor of a delay. Mara McDermott, vice president of federal affairs at CAPG in Washington, told MedPage Today that most of the physicians CAPG represents have been preparing for theses changes since 2006, and many have already applied to be a Next Generation Accountable Care organization. CAPG represents physician organizations that practice capitated, coordinated care.
"We're very concerned about delay, leading to more delay," said McDermott, who did not sit on the panel.