MACRA Implementation

Medical Groups Push Congress for Continued QPP Flexibility

October 09, 2017 01:06 pm News Staff

The AAFP recently joined more than 100 national and state specialty medical organizations in urging Congress to enact legislation that would ensure CMS has the flexibility to continue its incremental approach to implementing the Quality Payment Program (QPP).

[Sign that reads Keep Going leaning against brick wall]

The Oct. 2 letter(5 page PDF) was formally addressed to Rep. Greg Walden, R-Ore., Chair of the House Energy and Commerce Committee, and Rep. Frank Pallone, D-N.J., ranking member of the committee, but also was sent to the chairs and ranking members of the House Ways and Means Committee and the Senate Finance Committee.

The letter noted that since enactment of the Medicare Access and Chip Reauthorization Act (MACRA), the organizations have worked diligently with policymakers and CMS to ensure that implementation of the law aligns with Congress' intent to "focus payment on improving quality and value" while enabling physicians to successfully participate.

The letter noted that statutory provisions were created to provide flexibility during the implementation process, and as a result, practices have been able to jump in from the outset and increase their participation over time as they become more comfortable with the new reporting requirements.

Story Highlights
  • The AAFP and more than 100 other medical specialty organizations joined together to ask congressional leaders to extend existing flexibilities in the Medicare Access and CHIP Reauthorization Act for another three years.
  • The letter noted that giving physicians leeway in some of the statute's provisions will increase physician engagement and continued participation.
  • Congress created the law to focus payment on improving quality and value -- and wanted to ensure that physicians were able to successfully participate.

The flexibility has been beneficial to CMS, as well, and has given the agency additional time to finalize cost measures, improve data feedback and create tools to help physicians and other eligible professionals succeed.

However, noted the organizations, CMS soon will be required to publish proposed rules to cover the program's third year of operation.

Before that occurs, the organizations urged CMS to take note of several MACRA provisions that have ensured successful implementation to date.

For instance, to account for the lack of readiness of resource use measures in the first year of the Merit-based Incentive Payment System (MIPS) program in 2017, the HHS secretary was given leeway to weigh the resource use component at 0 percent, which was done for 2017 and is proposed for 2018.

The organizations called the action "an acknowledgment" that the new measures need to be developed and integrated in a way that will accurately reflect the complexities of cost measures and to ensure that they do not "inadvertently discourage clinicians from caring for high-risk and medically complex patients."

Another provision the organizations deemed critical to the continued successful implementation of MACRA is the flexibility that allows the HHS secretary to select a performance threshold during the first two years that is other than the "mean or median" standard.

Increasing the performance threshold gradually helps physicians implement practice changes as they gain experience. Setting the performance threshold too high "could discourage participation or negatively impact practices with fewer resources," said the letter.

Unfortunately, noted the organizations, both of these provisions will expire after the second year of the MIPS program.

That means that unless Congress acts, "CMS will be required by statute to implement a 'mean or median' performance threshold and count resource use measures for a full 30 percent of the performance score, regardless of the readiness of those measures or their applicability to a particular practice."

The proposed rule is due from CMS in the spring of 2018.

Therefore, said the organizations, "We are proposing to continue the existing flexibility in the MACRA statute that CMS is currently using for an additional three years so that the agency may move forward as the necessary program elements are put in place."

The letter also asks for additional modifications to MACRA provisions that would

  • clarify that Medicare Part B drugs -- and other items and services outside the physician fee schedule -- are not included in the application of MIPS payment adjustments and determination of MIPS eligibility,
  • better define the term "small practice," and
  • authorize the Physician-Focused Payment Model Technical Advisory Committee to provide technical assistance to developers of the QPP advanced payment models.

"We do not believe that these elements are being implemented in a manner consistent with congressional intent, and some technical changes in the legislative language are likely required," the letter concluded.

Related AAFP News Coverage
MACRA: The Medicare Access and CHIP Reauthorization Act

More From AAFP
MACRA Ready: The Shift to Value-Based Payment