Family medicine wins with MACRA, the Medicare Access & CHIP Reauthorization Act. The only way family physicians lose is to not participate.
“MACRA points the way to a patient care model that pays differently and pays better,” said Shawn Martin, AAFP Vice President of Advocacy, Practice Advancement, and Policy. “This puts us on a pathway to reform that is very advantageous to our patients, to us and to our country.”
Martin provided a glimpse into the future of Medicare reimbursement during the second General Session on Thursday afternoon.
MACRA replaces the Sustainable Growth Rate (SRG) formula that has hamstrung physicians for 17 years. The bill was passed with strong bipartisan support in Congress last year, but the proposed regulations issued by CMS in early 2016 were a disaster in the making.
With more than 900 pages of regulation, the CMS proposal threatened to shred primary care and other specialties with significant numbers of small and solo practices. The Academy swung into action with 107 pages of single-spaced questions, comments, and objections.
CMS listened. Earlier this month, the agency changed implementation rules to provide greater flexibility for smaller practices and allow them to avoid financial penalties in the early stages of implementation.
“MACRA has more than 900 pages of regulations for a 125-page bill,” Martin said. “Even by Washington standards, that’s overkill. What we need is a longitudinal payment model that pays family physicians to engage in the ongoing wellness of their patients, not just deal with episodes of illness. MACRA will allow you to take care of patients, not provide health care services to clients.”
Providers now have four levels of participation in MACRA. The easiest alternative is a short-term trial.
The most aggressive move is full participation in an alternative payment method, or APM, which also carries a five percent incentive payment. Few APMs have been created, Martin said. Most family physicians will use the merit based incentive payment system (MIPS).
MIPS effectively rolls up existing quality programs, including the Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier (VBPM) and Meaningful Use.
MACRA originally contained penalty provisions to encourage provider participation, but CMS created a simple safe harbor in response to the Academy’s comments. As long as a practice participates at some level at some time during 2017, it will escape payment penalties in 2019.
The details of MACRA regulation still run to hundreds of pages, but it all boils down to four basic rules for 2017.
- Report quality data. There are a variety of metrics and reporting techniques
- Use technology. You don’t have to love your electronic health record, but you have to use it.
- Evaluate your resource use. Don’t ration care, just evaluate how resources are being used
- Engage in clinical improvement activities such as FMX.
Those four rules are unlikely to change following the election, predicted veteran political analyst David Wasserman. Democrat Hillary Clinton has the second lowest confidence level of any major presidential candidate in history, 37 percent. Republican Donald Trump has the lowest confidence level ever, 28 percent.
“Voters have two choices this year, neither of which they like very much,” Wasserman said. “They also have no viable alternatives. This is the year of electile dysfunction.”
Clinton is likely to win, he said, although it is possible to imagine scenarios that allow Trump to rack up 270 electoral votes. Republicans are all but certain to retain control of the House, and the Senate could go either way.
The impact on health care could be similar regardless of who wins the presidential race. If Trump wins, he will likely work with Republicans to overturn the Affordable Care Act. Wasserman added that it seems likely that repeal or defunding would bog down in arguments between different factions within the Republican party.
If Clinton wins, ACA is safe from repeal. And fixes would bog down as Congressional Republicans and Democrats spend more time blaming each other for inaction than working together to improve the system.
“We will need more political courage in Congress than we are likely to see to bring about any significant change,” Wasserman said.