AAOS November 14, 2017
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House Hearing on MACRA and APM

On November 8, 2017, the House Energy and Commerce Subcommittee on Health held a hearing titled “MACRA and Alternative Payment Models: Developing Options for Value-based Care.” Subcommittee Chairman Michael C. Burgess, M.D. (R-TX) convened the hearing to discuss the implementation of one of the two tracks eligible professionals can be reimbursed under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) – Alternative Payment Models (APMs). The committee reviewed Medicare payment reforms, including models that are already under way and those that are returning savings to the program while improving outcomes.

The committee also discussed the Physician-Focused Payment Model Technical Advisory Committee (PTAC), which was created by MACRA to evaluate physician-focused APM proposals (PFPM). CMS is required to provide a detailed response to any physician led PTAC endorsed APM proposal. PTAC is comprised of 11 members, all of which are appointed by the Comptroller General of the United States. Members include both physicians and non-physicians, all of whom have expertise in PFPMs and delivery of care. PTAC evaluates stakeholder-submitted proposals against criteria established by the Secretary of HHS and makes recommendations regarding the future of those proposals.

Chairman Burgess began his opening statement by emphasizing that movement towards APMs has allowed providers greater flexibility to innovate and produce better patient outcomes, noting that the initiatives discussed are physician-directed and physician-led. He emphasized that physicians are best suited to provide the determinants of quality in order for MACRA to reach its full potential. Ranking Member Gene Green (D-TX) commented that staunch oversight of MACRA is critical in order to avoid the pitfalls of previous systems.

“Before MACRA, Congress delayed cuts to Medicare reimbursements for physician services a total of 17 times,” Dr. Burgess stated. “Through the hard work and steadfast leadership of the Energy and Commerce Committee and unwavering commitment of the medical community, this bipartisan effort led to policies that sought to put power back in the hands of those who actually provide care. That way, doctors will give shape to the health care payment systems of the future. So, it is critically important that MACRA succeeds, and I am glad that the Committee remains dedicated to ensuring we get payment reform right.”

Ranking Member Frank Pallone (D-NJ) of the full committee stressed that value-based models, such as accountable care organizations (ACOs), help to prioritize patients, improve care coordination, and lower costs.

In testimony submitted to the committee, AAOS noted that it has continued to work with members of Congress and the Centers for Medicare & Medicaid Services (CMS) as the rules for years one and two of this new framework are finalized, and “we remain committed to ensuring the legislation is improved over time.”

“Certainly, opportunities to examine and refine the MACRA framework – such as that provided by today’s hearing – will ensure the legislation improves delivery of care for Medicare patients across the country,” AAOS stated. “Nevertheless, in the spirit of the MACRA legislation, the AAOS has consistently requested reductions in unnecessary and burdensome requirements to qualify for Advanced APMs that cause resources to be spent on administrative costs rather than patient care…”

Read the full AAOS letter online here: http://docs.house.gov/meetings/IF/IF14/20171108/106599/HHRG-115-IF14-20171108-SD005.pdf.

Dr. Jeffrey Bailet, MD, Chairperson of PTAC, began his testimony by pointing to the readiness and demand for change from members of the physician community, including a willingness to participate in alternative payment models and to accept some form of risk, either two-sided risk for total cost of care, variants of capitation, and risk for achieving quality outcomes. Dr. Bailet closed his statement by stressing the importance of closer coordination between PTAC, CMS, and CMMI in order to enable greater efficiency and clarity for applicants.

Ms. Elizabeth Mitchell, also with PTAC, stressed the urgency to reduce healthcare costs while improving quality. She identified the need for technical assistance, greater access to shared data, and limited scale testing of innovative models. She explained that small and rural practices often lack the technical support to implement care changes for value-based care. Ms. Mitchell emphasized the need to identify barriers to community-wide data access to enable the transition to APMs.

“During today’s hearing, I was encouraged by the witnesses’ testimonies on the positive impact that MACRA has already had in their communities and the promise of delivering better care and driving greater savings for more providers,” stated Dr. Burgess after the hearing concluded. “A recurring theme we also heard this morning was that physicians are best suited to provide the determinants of quality. It is clear that patients are counting on us – the doctors – and not federal agencies, to get this right… The days of the Sustainable Growth Rate are long gone, but I look forward to remaining engaged and working hard to ensure doctors have the freedom to provide their patients with the best medical care.”

Find all testimony and a recording of the hearing online here: https://energycommerce.house.gov/hearings/macra-alternative-payment-models-developing-options-value-based-care/.