Posted by Anne Phelps, US Health Care Regulatory Leader, and Daniel Esquibel, Senior Manager, Deloitte & Touche LLP on March 18, 2016.
On March 17, 2016, Patrick Conway, Deputy Administrator for Quality and Innovation and Chief Medical Officer at the Centers for Medicare and Medicaid Services (CMS), testified at the House Energy & Commerce Health Subcommittee’s hearing on implementation of the new Medicare payment law, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Overview of MACRA
MACRA repeals the Sustainable Growth Rate (SGR) formula and establishes a path toward a new payment system that will more closely align reimbursement with quality and outcomes measures while steering health care providers to participate in risk-bearing coordinated care models and away from the fee-for-service reimbursement system.
The law specified payment updates under the Medicare physician fee schedule for all years in the future and creates two payment tracks for clinician’s paid under the physician fee schedule. Clinicians who receive a substantial percentage of revenue through certain Alternative Payment Models (APMs) will be eligible for bonus payments of 5% of estimated Medicare charges each year from 2019 through 2024. Clinicians who remain in the fee-for-service system will participate in the Merit-based Incentive Payment System (MIPS), a pay-for-performance program that ties individual clinician’s payment adjustments to their performance in four performance measures: Quality, Resource Use, Use of a Certified Electronic Health Record (EHR), and Clinical Improvement Activities. Existing reporting programs — Physician Quality Reporting System (PQRS), Value-based Modifier (VM), and Meaningful Use of EHRs for eligible health care providers (MU) — will be consolidated into MIPS and sunsetted after 2018.
Highlights of the Hearing
Overall, there was overwhelming bipartisan support of the law and the direction in which it is pushing Medicare and the US health care system. Both Republicans and Democrats are fully behind this law and committed to implementing it per the timetable in the statute. Notably, Congressman Michael Burgess (R-TX), a leader of the House Doctors Caucus who was very supportive of MACRA, said the timeline was included in the statute in part to avoid “bureaucratic inertia.” He also described MACRA as “disruptive by design” and key to the long-term sustainability of the Medicare program.
In addition, Conway heavily emphasized that MACRA facilitates alignment among payers, referencing CMS’ work with the Health Care Payment Learning & Action Network, which includes private payers, health care provider organizations, consumer groups and other stakeholders.
Conway said CMS is “working expeditiously” on the proposed rule on the MIPS and confirmed that it will be released this spring. Based on his comments throughout his testimony, CMS is hoping to get significant feedback to the proposals they will outline in the rule.
Some of the key takeaways from this session include:
1) There will be a “reasonable set” of options for clinicians to consider in order to qualify for the 2019 bonus payment; and
2) The set of APMs will grow over time. Conway emphasized that once the Physician-Focused Payment Model Technical Advisory Committee (PTAC) releases its criteria for assessing APMs, organizations can propose new models to be considered as APMs. This criteria is due by November 1, 2016.
For more information regarding MACRA and how it may affect your organization, please contact:
US National Health Care Regulatory Team
Senior Manager | Deloitte Advisory
Deloitte & Touche LLP