CMS’ Slavitt promises 'outside-in approach' for addressing MACRA concerns

In a speech at the American Medical Association’s annual meeting in Chicago, CMS Acting Administrator Andy Slavitt emphasized the agency is dedicated to working with physicians on the proposed rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA), especially to address worries about its effect on smaller practices.

Slavitt said much of the feedback from physicians has been over concerns that new regulations will have doctors and their offices spending more time on paperwork and less on patient care, and his response has been to say MACRA will have the opposite effect.

“So let me be clear, while it can be an understandable distraction, the goal of the program is to return the focus to patient care, not spend time learning a new program,” Slavitt said. “Medicare will still pay for services as it always has, but every physician and other participating clinicians will have the opportunity to be paid more for better care and for making investments that support patients—like having a staff member follow up with patients at home.”

To help physicians become acquainted with the new payment models so they can provide better feedback, he said the agency has hosted 135 events, such as webinars, specifically for clinicians since the rule was proposed in April.

“I will confess this is a new way of working for CMS,” Slavitt said. “I know from my time outside, CMS can appear to be a black box with opaque regulations and limited back and forth about our policy reasoning or our implementation constraints. People won't always agree with us and that's okay. We also need to be convincible when we have something wrong or need to re-steer in a different direction as we recently did with Meaningful Use.”

So where does he see room for change? He specifically mentioned providing extra support for small practices who may become quickly overburdened by any increase in paperwork. The law provides $100 million in technical assistance for smaller and rural practices, but Slavitt went further in the question-and-answer session following his speech, saying he’d be open to extending the deadline for compliance for smaller practices.

Echoing earlier comments from AMA CEO James L. Madara, MD, Slavitt promised to act on physicians’ concerns about health IT vendors. He said interoperability is held back more due to those vendors’ “business practices than technology capability and we cannot tolerate it any longer.”

“Along with relief from Meaningful Use, this is the number one ask of many physicians,” Slavitt said. “As in the rest of our lives, the burden needs to be on the technology, not the user. EHR vendors and hospitals that use them will now be required to open their APIs so data can move in and out of an application safely and securely.” 

The overall message of Slavitt’s speech was CMS wants physicians’ feedback on the proposed MACRA rule. While acknowledging healthcare professionals have had a rocky relationship with CMS in the past, he asked them to avoid cynicism about the new regulations and be actively engaged in the process.