Lawmakers Urge Doctors to Be Proactive on New Pay Models

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By Nathaniel Weixel

April 19 — Lawmakers during an April 19 hearing urged doctors to be proactive in preparing for the implementation of a new Medicare payment system rather than waiting for the CMS to issue a proposed rule.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is intended to make the Medicare payment and delivery systems for physicians more quality-focused. During a House Energy and Commerce health subcommittee hearing, lawmakers said physicians should take steps to develop new quality measures and evaluate which MACRA payment model will be right for their practices. The Centers for Medicare & Medicaid Services is expected to issue formal rulemaking on implementing the law in the very near future.

“Rather than wait until CMS issues a proposed rule on how they plan to implement these incentives and program changes, there are steps every practitioner can be taking right now,” subcommittee Chairman Joe Pitts (R-Pa.) said.

MACRA was passed over a year ago. It replaced the sustainable growth rate, a formula that led to continual cuts in Part B provider payments that were overridden by Congress.

The proposed rule (RIN 0938-AS69), which will establish the details for the new value-based payment system, has been under review by the White House Office of Management and Budget since March 25 (60 HCDR, 3/29/16). CMS officials have said that the proposal would be released in the spring.

Flexibility Urged

Physician groups told Congress that the CMS needs to be flexible with implementing the law and work with doctors to ensure the transition is smooth and efficient.

The CMS “needs to tread cautiously” when asking providers to start taking on risk, Jeffrey Bailet, co-president of the Aurora Health Care Medical Group in Milwaukee, told the panel. “There is and will continue to be a significant learning curve as providers begin to take on financial risk.” Bailet said the CMS should provide an incremental approach to value-based payment systems.

Barbara McAneny, speaking on behalf of the American Medical Association, said the agency needs to clearly define how it asks doctors to accept the financial risks of a quality-based reimbursement program.

“If CMS defines financial risk too narrowly, it will only recognize the most advanced practices and risks slowing momentum towards adopting new model,” McAneny said.

Two Tracks

Starting Jan. 1, 2019, the new system would implement a two-track payment method. One track, the Merit-Based Incentive Payment System (MIPS), would score medical professionals based on performance. MIPS will consolidate the current performance-based payment programs known as the Physician Quality Reporting System, the Value-Based Modifier and the Electronic Health Records Incentive Program into one.

For the second track, the rule would establish criteria for alternative payment models (APMs) that would allow providers to avoid the scoring and receive a 5 percent bonus if they join an eligible entity. APMs are provider payment structures that are expected to take the form of accountable care organizations, bundled payments and advanced primary care medical homes. Qualifying APM participants must have a specified amount of their Medicare expenditures or patients through an eligible APM.

To contact the reporter on this story: Nathaniel Weixel in Washington at

To contact the editor responsible for this story: Janey Cohen at