AAFP Takes Seat at MACRA Table on Capitol Hill

Board Chair Wergin Testifies Before House Subcommittee

April 20, 2016 02:50 pm Sheri Porter Washington, D.C. –

AAFP Board Chair Robert Wergin, M.D., testifies on behalf of family physicians at the House Energy and Commerce Committee's Subcommittee on Health.

Big changes are coming in how physicians are paid through Medicare, and the AAFP is working to ensure that family physicians are ready.

As part of that effort, AAFP Board Chair Robert Wergin, M.D., of Milford, Neb., testified here on April 19 about what the AAFP is doing to help family physicians succeed in new payment models associated with the Medicare Access and CHIP Reauthorization Act (MACRA).

Supporting documents and a video of the entire hearing before the House Energy and Commerce Committee's Subcommittee on Health are available online.

Joining Wergin on the physician panel were Barbara McAneny, M.D., medical director and CEO of Innovative Oncology Business Solutions, representing the AMA; Jeffery Bailet, M.D., EVP of Aurora Health Care; and Robert McLean, M.D., associate clinical professor of medicine at the Yale School of Medicine, representing the American College of Physicians.

Story Highlights
  • On April 19, AAFP Board Chair Robert Wergin, M.D., testified before a congressional subcommittee about physician preparedness for the Medicare Access and CHIP Reauthorization Act.
  • Wergin informed members of the House Energy and Commerce Committee's Subcommittee on Health that the AAFP is dedicating considerable time and effort to ensuring family physicians' success with new payment models.
  • He pointed out areas of particular concern to the AAFP, including interoperability of electronic health records, simplification of rules and elimination of administrative burdens.

Subcommittee members were eager to learn how physician organizations were preparing their members for implementation of the new Medicare payment reforms and what Congress could do to help.

In his opening statement, subcommittee chair Rep. Joe Pitts, R-Pa., said, "Through a variety of incentives, MACRA encourages physicians to engage in activities to improve quality, patient experience and outcomes, and reduce costs."

He noted that prior to MACRA, "physicians not only faced the threat of unsustainable cuts from the SGR (Medicare sustainable growth rate), but a series of well-meaning but uncoordinated requirements stacked on top of each other…

"MACRA seeks to consolidate, streamline and integrate these into a single program," he said.

Oral Testimony

Wergin thanked the legislators for helping to repeal the SGR and for "putting into place payment reforms that clearly emphasize value-based health care."

He noted that the implementation of MACRA would mean dramatic changes to Medicare in a short period of time. However, the changes "are consistent with the key principles of practice transformation that the AAFP has supported for over a decade," Wergin added.

"We believe that the practice transformation necessary to make MACRA successful will mean better care for patients, better professional experiences for physicians and better control of health care costs," said Wergin.

"We hope it that it will bring back the joy of medicine."

Physicians are concerned about the changes ahead, he said. "I urge them to take advantage of the AAFP's resources that they can utilize to begin transforming their practices now."

Wergin noted that MACRA was designed to transform the U.S. health care delivery system "into one that is based on a strong foundation of primary care."

He said that the complex care that primary care physicians provide "helps improve patient outcomes and constrain overall health care costs."

Furthermore, alternative payment models (APMs) that are part of MACRA "will improve how the health care system values primary care and the services that are fundamental to disease prevention, chronic care management and population health -- all areas of health care that a fee-for-service system cannot adequately address."

Wergin told the subcommittee that despite the significance of MACRA, many family physicians are uncertain of their level of readiness. "The AAFP has launched a comprehensive, multi-year, member education and communications effort designed to simplify the transition," he said.

He noted that his written testimony(docs.house.gov) included AAFP recommendations to CMS about how to make the law more physician friendly.

Questions and Answers

After the physicians completed their oral testimony, members of the subcommittee directed questions to the panel.

AAFP Board Chair Robert Wergin, M.D., consults with AAFP Government Relations representatives Andrew Adair and Sonya Clay prior to a House subcommittee hearing on physician preparedness for the Medicare Access and CHIP Reauthorization Act.

In response to a question about what physicians can do to succeed in the Merit-based Incentive Payment System (MIPS) that is part of MACRA, Wergin shared with the subcommittee one of the resources the AAFP created to help guide family physicians through the transition.

He told the panel that preparing for implementation of MACRA presents special challenges to family medicine because of the diversity in practice types -- from small rural practices to large health systems.

But whatever the practice setting, Wergin told the subcommittee his message to members is the same: "I tell them now is the time to prepare for MACRA."

Physician panelists agreed that the lack of details about the implementation rules was creating a high level of anxiety for physicians.

Subcommittee members asked if CMS was proactive in its approach to writing the rules, if it was open to comments from outside entities and if it had the expertise necessary to complete the job.

The panel affirmed support for CMS' efforts. Wergin added that one of the AAFP's key messages to CMS is, "Keep it simple and reduce our administrative burden."

In response to a query about potential opportunities MACRA offers physicians, Wergin said the AAFP is pleased to see primary care finally gain the recognition and value that it has long deserved. The realization of those promises could go a long way toward easing the nation's family physician shortage, he added.

Specifically addressing the promise that MIPS and APMs hold for family physicians, Wergin said, "In fee-for-service we were undervalued."

He also took the opportunity to stress the importance of aligning quality measures that currently vary from payer to payer. Wergin told the subcommittee that when a patient asks him about creating a care plan, his first question must be, "What insurance do you have?"

When a subcommittee member asked what Congress could do to help physicians succeed, Wergin stressed the importance of interoperable electronic health records in improving efficiency and providing quality care. He said it wasn't unusual for him to receive an 18-page faxed document from the local emergency room filled with irrelevant patient information.

The subcommittee also asked Wergin about the specific challenges of practicing in a rural area.

"Rural providers have limited resources," so we need to be innovative, Wergin said. For instance, he leans on local church groups when a patient needs food assistance. And utilizing telehealth technology is an option for physicians in areas where mental health services are unavailable.

And the challenges to remaining in rural practice?

Wergin said burnout was a real problem for a rural physician who may be the only source of primary care for thousands of patients in multiple counties.

"Patients love you -- almost love you to death," said Wergin, recalling the anxious patient who asked, "Can't you put in my aortic valve?"

Tuesday's hearing was the second in recent weeks that focused on MACRA. In March, subcommittee members discussed CMS' ongoing work to develop rules for implementation.

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