AAOS April 3, 2018
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MACRA Oversight Hearing

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House of Representatives Legislative Activities

Senate Legislative Activities

MACRA Oversight Hearing

On March 21, the House Ways and Means Subcommittee on Health, chaired by Rep. Peter Roskam (R-IL) held a hearing on “The Implementation of MACRA’s Physician Payment Policies.” MACRA (the Medicare Access and CHIP Reauthorization Act of 2015) ended the Sustainable Growth Rate formula and replaced it with the Quality Payment Program, which includes two tracks: the Merit-based Incentive Payment System (MIPS) track and the Advanced Alternative Payment Models (APMs) track.

This hearing was a chance for Members to discuss with witnesses from the Centers for Medicare and Medicaid Services (CMS) about the implementation of MACRA and better understand its role in creating more valuable, patient-centered care for seniors and other beneficiaries. As Chairman Roskam said at the start of the hearing:

“Our role as Congress is to provide oversight, and in conjunction with CMS, continue to provide education on how our law is working for providers in Medicare. … We hope to continue to hear from stakeholders and work with CMS in implementing this law correctly, and ensure that we achieve the goal that I believe we all share, that MACRA work as intended.”

Demetrios Kouzoukas, Principal Deputy Administrator for CMS, highlighted to the subcommittee four key areas that Health and Human Services Secretary Alex Azar has prioritized to improve our nation’s health care systems – emphasizing that these are shared goals for CMS for implementing MACRA:

  • “First, give consumers greater control over their health information through interoperable and accessible health care information technology… Allow them to get their information in their hands so they can move around and be consumers in a health care market.
  • “Second, encourage transparency for patients and providers so that patients can make choices based on pricing and quality as they would in any other market.
  • “Third, leverage the power of patients and put resources behind them by using the authorities at [the Center for Medicare and Medicaid Innovation]…to help drive value and quality through the entire system.
  • “Last, reduce government burdens that impede this transformation by ensuring that patients can spend more time talking to their physicians and facing them in one-on-one conversations rather than looking at the back of their lab coat. These are the same principles that guide our implementation of Congress’ vision for Medicare clinician payment through MACRA.”

Throughout the hearing, members of Congress discussed challenges that they have heard about from medical providers in their districts regarding MACRA implementation and asked what actions are currently being pursued by CMS to improve this important program. For example, Rep. Kenny Marchant (R-TX) expressed concerns regarding “Stark Law” – a set of federal prohibitions placed upon physicians regarding Medicare or Medicaid patients – and how a lack of modernization of these laws would restrict the success of MACRA. Rep. Erik Paulsen (R-MN) asked what CMS is considering in terms of opening up opportunities for stakeholders across all medical sectors to innovate and collaborate in value-based arrangements, both within and outside of MACRA. Rep. Diane Black (R-TN) stressed how important it is that there be a focus on rural communities as Congress and CMS work to create a more patient-centered health care system.

In response to the hearing, AAOS submitted a statement for the record, noting that we have worked with both members of Congress as well as CMS to provide suggestions that would address some of these concerns and ensure the requirements do not interfere with the patient-physician relationship. The statement highlighted areas of concern with the MIPS track, problems with risk adjustment and the budget neutrality component, as well as general issues with APMs, Stark law reform, and QCDRs.

“Specifically, for the shift to value-based health care to be successful, the MIPS program will have to be more inclusive and introduce greater flexibilities for small, solo, and rural practices,” the statement reads. “According to our most recent census report, more than half of all orthopaedic surgeons are in private practice, with 11 percent of orthopaedic surgeons in solo private practice. As mentioned above, these physicians generally face the most challenges in meeting the requirements imposed by MACRA. Recent updates to the low-volume threshold certainly help in this regard, but more changes can be made.”

Chairman Roskam closed the hearing by asking what CMS wants lawmakers to be focused on as they continue their work to improve Medicare. Mr. Kouzoukas stressed that “value-based care means patients are in the driver’s seat. …if we do that, we will ensure value-based health care isn’t something that is created in Washington but an opportunity for each patient to decide for themselves and assemble for themselves health care.”