House members ask HHS to ‘consider flexibilities’ on MACRA start date

Leaders on two powerful House committees encouraged HHS Secretary Sylvia Burwell to “consider flexibilities” in implementing the major changes to physician payment required by the Medicare Access and CHIP Reauthorization Act (MACRA).

The letter was signed by the Republican chairmen and ranking Democrats on the House Ways and Means and Commerce and Energy committees, along with the chairmen and ranking members for their health subcommittees.

The lawmakers didn’t recommend delaying the implementation of the new payment systems and quality measures, which was a frequent suggestion in comments on the proposed rule and has been mentioned as a possibility by CMS Acting Administrator Andy Slavitt.

“The Congressional intent for MACRA was twofold,” the congressmen wrote. “To consolidate, streamline, and ease the burden of the various quality reporting programs for physicians and practitioners and to incentive quality, value-based care through aligned payment bonuses and penalties for physicians and practitioners. With these principles, we encourage CMS to ensure that all physicians and practitioners have an equal opportunity to succeed under the Quality Payment Program.”

Concerns about whether MACRA provides that equal chance for success have been raised since the rule was first proposed. Accountable care organizations participating in the Medicare Shared Savings Program have asked to be allowed into MACRA’s Advanced Alternative Payment Models (APM) track and CMS has offered $100 million in technical assistance to smaller, rural practices.

The letter lists several areas it wants the agency to help practices to succeed in, including “simplified, streamlined, coordinated requirements,” offering opportunities to move into the APM track, rewards for “significant delivery system reform activities” in both payment tracks and having the “appropriate systems ready and in place” for reporting to begin in January 2017.

While the American Medical Association and the American Academy of Family Physicians, among others, have said the January start date won’t work, the congressmen may have a different opinion.

Their letter said while MACRA does represent a significant shift in payment and quality reporting, they believe physicians “are ready for these changes” because of their experience with programs now incorporated into the Merit-Based Incentive Payment System (MIPS), like the Physician Quality Reporting System (PQRS), the Value Based Modifier (VBM) and Meaningful Use (MU).