MACRA — the Medicare Access and CHIP Reauthorization Act — was enacted in 2015 in an unusual bipartisan effort among the leaders of both the House and Senate, passing by almost unanimous margins in both houses before being signed into law by President Obama. MACRA repealed the Sustainable Growth Rate (SGR) formula, which had been annually threatening to make 25-30% cuts in physicians’ payments for services to Medicare beneficiaries, but rather than replacing SGR with a single new method of physician payment, the law created two alternative paths for physicians — the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). MIPS was intended to consolidate and simplify multiple pay-for-performance programs in Medicare, and APMs were intended to encourage physicians to move away from the traditional fee-for-service payment system. In addition to creating financial incentives for physicians to participate in APMs, Congress encouraged physicians to develop APMs themselves — it created the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to accept proposals for APMs from physicians and other stakeholders and make recommendations to HHS as to whether the proposals merited implementation.
Both MIPS and APMs were expected to accelerate progress toward higher quality care for patients and lower healthcare spending. However, four years after the passage of MACRA, the Centers for Medicare and Medicaid Services (CMS) is still struggling to implement both MIPS and APMs in ways that achieve these goals:
- The MIPS program has been widely criticized for increasing the administrative burden on physicians. The quality measures and performance methodology have been criticized for failing to encourage meaningful improvements in value and for penalizing small physician practices and physicians that treat higher-risk patients. The Medicare Payment Advisory Commission has called for abolishing the MIPS program.
- Most physicians have not even had an opportunity to participate in an APM because of the small number and narrow focus of the APMs that have been implemented by CMS. Moreover, those APMs that have been implemented have had disappointing results in terms of savings. PTAC has received and reviewed more than 30 proposals for new types of physician-focused APMs and it has recommended that HHS implement or test more than a dozen of the proposals, but as of March 2019, none of PTAC’s recommendations had been implemented.
Significant changes are expected in 2019. HHS Secretary Alex Azar has made valuebased transformation of the healthcare system one of his four priorities, and he has committed to creating bold new payment and delivery models in both Medicare and Medicaid. Secretary Azar appointed Adam Boehler as both the Director of the Center for Medicare and Medicaid Innovation and the Secretary’s Senior Advisor for Value-Based Transformation and Innovation, and Director Boehler has announced that CMMI will implement several new Alternative Payment Models this year based on PTAC’s recommendations. CMS is expected to propose additional changes to the MIPS program this year to make it more effective and less burdensome.
The MACRA Summit will provide the most up-to-date information on new developments as well as insights on the challenges that still have to be overcome in order for Medicare to accelerate value-based payment systems. Speakers include top leaders from HHS and CMS, members of PTAC, physicians and hospitals who have been implementing existing APMs and developing new ones, and clinicians and researchers who are developing innovative approaches to quality measurement and risk adjustment.
WHO SHOULD ATTEND
- Health Care Attorneys and In-house Counsel
- Chief Financial Officers
- Chief Innovation Officers
- Directors of Accountable Care
- Directors of Quality Management and Improvement
- Directors of Government Programs
- Directors of Medicare Programs
- Directors of Medicaid Programs
- Directors of Network Contracting
- Directors of Provider Relations
- Directors of Finance and Reimbursement
- Pharmaceutical Executives
- Pharmaceutical Consultants