Bipartisan payment system improvements mean more physician participation and better patient care

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As a physician, I find it difficult to watch the continuous politicization of the health care debate. While I understand that there may be different (and strong) views on the most effective and efficient way for our country’s health care system to operate, all parties benefit when there is consensus and collaboration on the solution.

In my role as the spokesperson for the Alliance of Specialty Medicine, I saw this firsthand in the run-up to the passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This law represented the very best in how Congress should approach health care policy.

{mosads}Members and staffs of both chambers and both sides of the aisle met for hours on end to come up with the much-needed replacement of Medicare’s Sustainable Growth Rate (SGR) formula for reimbursing physicians. Committees of jurisdiction held hearings and markups and stakeholders like the Alliance were asked to testify or submit written comments.


The result of this inclusive process was a bill that passed the House 392-37 and the Senate 92-8 before heading to the president’s desk for signature.  

Given this amount of work and support in the crafting and passage of MACRA, the provider community is working with congress to implement some improvements to MACRA’s Merit-Based Incentive Payment System (MIPS).

These common-sense changes will help ensure that clinicians have sufficient opportunity and ability to digest, prepare for, and implement MIPS requirements. They will also provide the Secretary of the Department of Health and Human Services (HHS) the flexibility and time to more accurately and meaningfully assess clinician performance under this program.

Additional changes would provide clarification that would strengthen the MIPS program consistent with congressional intent. These include:

  • Providing the Secretary of HHS flexibility to set the resource use, or “cost” category of MIPS, at a lower weight than the statutory requirement of 30 percent, but not more than 10 percent, through the 2021 performance year;
  • Giving the Secretary of HHS the flexibility to continue setting the MIPS performance threshold at a level commensurate with clinician readiness, rather than the mean or median performance level required under current law, through the 2021 performance year; and
  • Clarifying that MIPS payment adjustments should apply only to covered professional services under the Medicare Physician Fee Schedule.

On Nov. 2, the Centers for Medicare & Medicaid Services (CMS) issued final program requirements for Year 2 of the program. Notably, the agency provided significant flexibilities for small practices, including addressing our concerns related to the definition of a “small practice,” providing bonus points for small practices, and allowing a special hardship exemption from the electronic health record performance category requirements for small practices.

Unfortunately, the rule failed to maintain a zero percent weight for the cost performance category as originally proposed, exclude Part B drugs from the MIPS payment adjustment, or set a more reasonable performance threshold based on clinician readiness.

The physician community, including specialists like me, continue to endorse MACRA’s payment reforms, but we want to reduce the regulatory burdens of the program, while also enabling a more accurate assessment of clinician performance on cost measures, provide relief necessary to allow clinicians to meaningfully engage with MIPS, and ultimately increase access to high-quality specialty care for Medicare beneficiaries. Doing so in a bipartisan way will only make MACRA better.

Dr. Alex Valadka is the Chair of the Department of Neurosurgery at Virginia Commonwealth University and is the spokesperson for the Alliance of Specialty Medicine.

Tags Health Health care Medicare Access and CHIP Reauthorization Act of 2015

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