House Committee Heads Want Simplified Medicare Doc Pay System

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By Mindy Yochelson

Sept. 6 — Requirements behind the new Medicare physician reporting and payment system shouldn't be onerous and all doctors should have the opportunity to participate in alternative payment models, House committee leaders from both sides of the aisle told the head of HHS Sept. 6.

Congress's intent in replacing the sustainable growth rate (SGR) formula with a new system under the Medicare Access and CHIP Reauthorization Act (MACRA) was to consolidate, streamline and ease the burden of the various quality reporting programs for physicians and other practitioners, the eight leaders said in a letter to Sylvia Mathews Burwell, secretary of the Department of Health and Human Services.

The eight represented the chairmen and ranking members of the full Ways and Means and Energy and Commerce committees and the two health subcommittees, which are in charge of Medicare legislation.

Clinicians have expressed concerns in comment letters and hearings that the quality reporting under the new system, called the Merit-Based Incentive Payment System (MIPS), is complicated. They have also said there are limited opportunities to join alternative payment models that would offer them a chance to receive extra funds (126 HCDR, 6/30/16).

The rule was proposed in April.

Goals of MACRA

“After reviewing the proposed rule and hearing from doctors and other health-care providers, our members wanted to reinforce the goals of MACRA before CMS finalizes the rule and moves forward with implementation of the law,” Lauren Blair Aronson, press secretary for the Ways and Means Committee, told Bloomberg BNA.

The letter was signed by Ways and Means Chairman Kevin Brady (R-Texas), the committee's ranking member Sander Levin (D-Mich.), Health Subcommittee Chairman Pat Tiberi (R-Ohio) and Health Subcommittee ranking member Jim McDermott (D-Wash.).

It was also signed by Energy and Commerce Chairman Fred Upton (R-Mich), the committee's ranking member Frank Pallone Jr. (D-N.J.), Health Subcommittee Chairman Joseph Pitts (R-Pa.) and Health Subcommittee ranking member Gene Green (D-Texas).

Moving to Other Track

The lawmakers asked that the Centers for Medicare & Medicaid Services ensure that there are opportunities for providers to move from the MIPS reporting system to the alternative payment model (APM) track to be “rewarded for meaningful delivery system reform activities.”

Anders M. Gilberg, senior vice president, government affairs for the Medical Group Management Association, called the letter “a reflection of legitimate concerns members of Congress are hearing from physicians and medical groups about the complexity of the recent proposed rule.”

He told Bloomberg BNA that it was “meant to remind CMS that Congress intended for MACRA to provide simple, clear opportunities for physicians to succeed under a new Medicare payment system.” However, as proposed, “CMS’s MIPS criteria are overly complex and CMS’s definition of APMs too restrictive,” he said.

Bob Doherty, senior vice president, governmental affairs and public policy, American College of Physicians, told Bloomberg BNA that by weighing in before the final rule is released in late October or early November, “the committee has more of an opportunity to ensure that CMS meets Congress's intent to simplify the burden on physicians of reporting on quality measures and creates opportunities for physicians in all specialties and practice sizes, especially those in smaller practices, to succeed.”

Start Date for Reporting

The letter asked that the CMS have “appropriate systems ready and in place” for reporting to begin by January 2017.

Performance in 2017 will be used to grade and pay doctors in 2019, the first year of MACRA implementation.

Some provider groups have asked that the reporting be delayed until July 2017, including the American Association of Neurological Surgeons, which expressed disappointment that the members' letter didn't ask for the six-month delay.

“It is simply impossible for physicians to start reporting under the new program in January 2017, particularly with only a couple of months preparation time following the publication of the final rules,” Katie O. Orrico, director of the group's Washington office, told Bloomberg BNA.

However, that sentiment wasn't universal.

Mara McDermott, vice president of federal affairs for CAPG, an association of physicians in managed care, said that many doctors are anxious for the new system to begin.

“Over the district work period, Congress heard from stakeholders in the physician community, including CAPG, who are ready to move ahead with MACRA in January 2017,” she said.

To contact the reporter on this story: Mindy Yochelson in Washington at myochelson@bna.com

To contact the editor responsible for this story: Kendra Casey Plank at kcasey@bna.com

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