ACP Offers Recommendations to Improve Effectiveness of MACRA

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Policy recommendations intend to strengthen the Medicare Physician Fee Schedule and reform physician payment to reduce health disparities

Nov. 18, 2022 (ACP) — The American College of Physicians is offering guidance about the future of the Medicare Access and CHIP Reauthorization Act (MACRA) and payments to physicians in response to a request from members of Congress for input.

In an Oct. 28 letter that builds on years of advocacy, ACP calls for immediate congressional action to prevent pending cuts to Medicare payment rates in 2023. ACP lays out a roadmap to support consistent and stable payment updates, make long-term improvements to Medicare and health care delivery, allow the reinvestment of savings into the Medicare program, and reform the MACRA and Merit-based Incentive Payment System (MIPS).

These policy recommendations “will strengthen the foundation of the Medicare PFS [Physician Fee Schedule], improve the effectiveness of MACRA, and reform physician payment to reduce health disparities and improve health equity,” wrote Dr. Ryan D. Mire, president of ACP, in the letter.

The congressional request for input was led by two physician members of Congress -- Rep. Ami Bera (D-CA) and Rep. Larry Bucshon (R-IN) — who have led the effort to reform MACRA.

“They're seeking information from health care stakeholders on actions that Congress could take to ensure that MACRA provides financial stability for physicians who care for Medicare patients,” said Brian Buckley, ACP senior associate for legislative affairs. “They intend to share these ideas with other members of Congress who are interested in reforming MACRA as well as the key committees that have jurisdiction over Medicare spending: the House Ways and Means and Energy and Commerce committees as well as the Senate Finance Committee. Reps. Bera and Bucshon hope that Congress will be able to use these ideas to craft legislation to reform MACRA in the future.”

In the letter, ACP makes these recommendations to Congress:

  • Act immediately to address the 4.42 percent Physician Fee Schedule cut to payment rates that is scheduled to begin on Jan. 1, 2023.
  • ACP strongly supports H.R. 8800, the Supporting Medicare Providers Act of 2022, which would prevent this cut, and is grateful to Reps. Bera and Bucshon for spearheading it. The bill is now before the House Ways and Means Committee with 90 cosponsors, Buckley said.
  • Ensure Medicare provides annual physician payment updates consistent with the Medicare Economic Index.
  • Implement long-term improvements to Medicare and health care delivery. ACP supports policies to ensure that MACRA fulfills its goals as intended to transform Medicare physician payment from a fee-for-service model that pays physicians based on the number of services provided to a value-based model that incentivizes the quality and outcome of care delivered to patients.
  • Support sufficient and sustained increases in Medicare payments for primary care services in a manner that is not limited by current budget neutrality constraints.
  • Ensure savings are calculated across all aspects of Medicare. ACP supports modifications to the Medicare law to establish a mechanism for savings to be calculated across all aspects of the program -- that is, increased investment in relative and absolute payments for primary care and preventive health care services (Part B) results in savings due to reduced emergency department visits and hospitalizations (Part A) — and to allow these savings to be reinvested back into primary and preventive care, as well as into social and public health services.
  • Improve the effectiveness of MACRA to achieve greater equity and value in health care. MACRA is “intended to provide strong incentives for physicians to engage in activities to improve quality; streamline existing quality reporting programs to reduce administrative burdens; and provide additional support to physicians who participate in APMs [Advanced Alternative Payment Models] shown to improve outcomes and the effectiveness of care provided,” Mire wrote in the ACP letter. “Unfortunately, our physicians have not achieved these goals in MACRA.”
  • Implement ACP recommendations to improve MIPS and APMs.
  • Adopt population-based Prospective Payment Models to improve health equity.

Going forward, Buckley said, “we hope the House and Senate committees with jurisdiction over Medicare will hold hearings concerning MACRA to consider the proposals that ACP and other groups submitted in the RFI [Request for Information]. And we hope that these committees will ask ACP to testify at these hearings to learn more about our specific ideas to reform this law.”

Then, ideally, Congress will enact the ACP recommendations, Buckley said.

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