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Tuesday Apr 28, 2015

Final Thoughts on the SGR; A Look Ahead at MACRA

A strange thing happened recently in Washington, the U.S. Congress passed meaningful and impactful legislation in an overwhelming, bipartisan manner -- and the President signed it into law!  

On April 16, the President signed into law(www.c-span.org) the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015 (MACRA) (Public Law 114-10), bringing to a close one of the more frustrating and disruptive health policies of modern times. After 13 years. and 17 short-term fixes at a cost of nearly $170 billion spent, we can now shout from the mountain tops that the SGR IS REPEALED!  

A round of applause and a heartfelt thank you to those who engaged with us on this important victory. Although we in Washington like to believe that we can make things happen, we understand fully that it is constituents who drive change, and we thank you for all you have done.

The enactment of this legislation was made possible by historic votes in the House of Representatives and Senate. All told, 484 members of Congress -- or 91 percent -- voted for the bill. AAFP News has an excellent story on the legislative actions and the official AAFP reaction.

For the AAFP, the enactment of this law brings to a close a sustained advocacy campaign that has spanned more than a decade. I want to publicly congratulate AAFP Director of Government Relations Kevin Burke and his team on this great accomplishment and thank them for their relentless pursuit of this legislative objective. It is hard to articulate or quantify the work done by Mr. Burke and his team, but I assure you it was significant.

So the question that likely is on many of your minds is, "what does the law do, and how does it impact me?" Great question. I encourage you to visit the Academy's MACRA resources. This Web page will be your one stop for information on MACRA and the resources the AAFP has available to assist you in your pursuit to implement and comply with the provisions of the law. Start with the Frequently Asked Questions document that provides a top-line summary of the law.

The most important provisions of MACRA are those that extended coverage and access to care for our nation’s children, seniors, and disabled. Extending coverage and access to physician services for these populations was a priority for the AAFP, and we are pleased that they were included.

For our members who see Medicare patients, the most important provision is the one that repeals the flawed sustainable growth rate (SGR) effective immediately. The elimination of this failed payment formula should be celebrated. Family physicians no longer face a lingering threat of losing one-fourth of their income due to the actions, or inactions, of Congress. The SGR not only impacted Medicare payment rates, but also influenced payment rates for commercial insurers who typically pegged their payment rates to a percentage of Medicare. This direct association between Medicare and the commercial insurers meant that a cut initiated by the SGR would reverberate throughout a physician practice. The annual threat of substantial reductions in payments due the SGR was unsettling for physicians.  

Starting on July 1, physicians participating in the Medicare program will receive a .5 percent increase in their payments. The .5 percentage increase will continue, annually, through 2019. All physicians participating in the Medicare program will receive these annual updates. Starting in 2019, physicians will have the option of pursuing their payments through an alternative payment model (APM) such as the patient-centered medical home or by staying in the fee-for-service system and participating in the Merit-Based Incentive Payment System (MIPS).  

I appreciate that there is anxiety with the transition to APMs and the MIPS program, but remember that this transition does not happen for five years. Furthermore, the law provides resources -- $100 million -- aimed at assisting small and solo practices in the transformation process, ensuring that these important care settings have resources to succeed under the new payment models. This $100 million will be leverage alongside the more than $800 million available in the Transitioning Clinical Practice Initiative (TCPI) launched by the administration last fall. All told, almost $1 billion will be invested in assisting physicians, especially those in solo and small practices, succeed in alternative payment and delivery models.

We also are pleased that starting in 2019 the meaningful use, Physician Quality Reporting System (PQRS), and value-based modifier programs will be consolidated into a single program under the MIPS. This will result in harmonized quality measures and a reduction in the administrative burden of quality improvement programs for those participating in Medicare. The AAFP has long been concerned about the complexity of CMS's programs and the administrative burden they placed on small family medicine practices. This burden often prevents small practices from maximizing opportunities in incentive programs.  

This law includes three provisions aimed at assisting solo and small practices remain independent, but also maximizing their ability to achieve full potential in alternative delivery and payment models. Those provisions will allow unaffiliated physicians to be evaluated in the MIPS as a virtual group, helping them lessen the burden of program’s requirements without sacrificing their independence; the Independent Risk Manager model, that would allow independent physicians to share risk without having to affiliate with a large system or accountable care organizations; and provisions that specifically look at ways in which fraud and abuse laws like the Anti-Kickback Statute may unintentionally be making it difficult for physicians -- particularly independent physicians -- to share risk in value-based models.

I know that change is both disruptive and daunting, but I contend that the provisions of this law are both good for family medicine and good for our health care system. The SGR was a truly horrible payment methodology that disrupted practices and perpetuated poor policy-making in Washington.  Good riddance to this horrible payment formula, and may we never speak its name again! 

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Stephanie Quinn, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.