Society Urges Congress to Further Improve MACRA

June 7, 2019
Policy Snapshot

In a letter sent this week to congressional leaders, the Society joined the American Medical Association and other national medical societies in urging Congress to make further refinements to improve the Medicare Access and CHIP Reauthorization Act (MACRA). The groups called on Congress to replace the 2020-2025 physician payment update freeze with positive payment adjustments for physicians, extend the Advanced APM bonus payments for an additional six years, and implement several additional technical improvements to MACRA.

MACRA included modest positive payment updates in the Medicare Physician Fee Schedule, but it left a six-year gap from 2020 through 2025 during which there are no updates at all. Following this six-year freeze, the law specifies physician payment updates of 0.75% and 0.25% for physicians participating in Alternative Payment Models (APMs) or Merit-based Incentive Payment System (MIPS), respectively. By contrast, other Medicare providers will continue to receive regular, more stable updates. As physician practice payments fall increasingly below their costs, patient access issues would arise.

“We urge Congress to replace the upcoming physician pay freeze with a stable and sustainable revenue source that allows them to sustain their practice and provides a margin to invest in the practice improvements needed to transition to more efficient models of care delivery and better serve Medicare patients,” the groups said.

The groups also urged Congress to extend the Advanced APM incentive payments for an additional six years. “One goal of MACRA was to provide physicians with a glide path to transition into more innovative payment models. Changing the way physicians deliver care requires significant investment in new technologies, workflow systems, personnel and training. To help physicians implement these changes, MACRA provided a five percent incentive payment for the first six years of the program for physicians who participate in Advanced APMs,” the letter stated.

The groups also called on Congress and the Centers for Medicare & Medicaid Services (CMS) to continue to engage the medical community to make technical changes to MACRA including:

  • Eliminating the requirement to set the MIPS performance threshold at the mean or median so CMS, rather than a pre-set formula, can determine whether physicians are ready to move to an increased threshold based on available data
  • Allowing CMS to develop multiple performance thresholds, such as one for small and rural practices, to ensure a level playing field for all physicians
  • Updating the Promoting Interoperability performance category to allow physicians to use certified electronic health record technology (CEHRT), health information technology that interacts with CEHRT, or a qualified clinical data registry (or a combination of all three technologies)
  • Prioritizing cost measures that are valid, reliable, and demonstrate variation by removing the requirement that episode-based cost measures account for half of all expenditures under Medicare Parts A and B

Click here  to read the entire letter.