What Will Happen to MACRA Under a Trump Administration?

MACRA repealed? Highly unlikely

With the Trump Administration now in charge, many have been asking what the impact will be on health care—specifically on the Medicare Access and Chip Reauthorization Act. With all the buzz around abolishing the Affordable Care Act, some hope that MACRA will receive the same fate.

No matter what side of the political fence you stand on, MACRA has been given bipartisan support in both houses of Congress, including a 392-37 vote in the House of Representatives. There is mutual agreement to push clinicians from volume-to-value. No one is eager to return to a Medicare reimbursement system that relied on separate reporting programs and the Sustainable Growth Rate. MACRA will most likely stick around—although its pace remains in question.

A new starting lineup

On February 10, the Senate approved the nomination of Representative Tom Price, M.D., to be secretary of the Department of Health and Human Services, putting him in charge of President Trump’s efforts to disassemble the Affordable Care Act (ACA).

NN&I's Roundtable on MACRA is available for replay

Adam Weinstein, MD, and Diana Strubler, Policy and Standards Senior Manager at Acumen Physician Solutions will help you understand how to navigate this complex payment system.

By a vote of 52-47, Dr. Price, an orthopedic surgeon from Georgia, is the first physician in this seat since 1993. His views include freedom for patients and physicians, and the sanctity of the patient-physician relationship.

After Price’s confirmation, many health groups sent their congratulations along with some requests.

The Association of American Physicians and Surgeons (AAPS) suggested making MACRA voluntary—this is a softer suggestion than their original recommendation of withdrawing it entirely. AAPS executive director Jane Orient, M.D, expressed that “HHS has denied or restricted freedom in medicine in countless ways.” Dr. Orient believes by making the program voluntary it could allow patients and physicians to decline MACRA and adopt payment based on patient value rather than by bureaucratically dictated value.

Another congratulatory letter was sent by the Medical Group Management Association (MGMA) who also echoed the AAPS by asking Price to reduce regulatory burden. They cited a 2016 Health Affairs study which concluded that physician spend, on average, 785 hours per physician and more than $15.4 billion per year on external quality reporting requirements. The letter also urged Price to open up more opportunities to participate in the track of MACRA.

Meanwhile, Seema Verma, CEO and founder of SVC Inc., has been nominated by Trump to run the Centers of Medicaid and Medicare Services. If confirmed, Verma will replace Andy Slavitt as CMS Administrator, who was an Obama administration appointee and huge advocate for the ACA. Verma is a proponent for MACRA and even applauded Congress for voting it in while saying, “it was an important step forward to provide stability for providers and move us toward better outcomes.”

In a recent senate committee hearing, she stated that small and rural providers will face many challenges and they will need the most support—many of these providers may never want to take on risk.

“There are concerns with fee-for-service, in terms of rewarding volume over quality. I do support efforts that hold providers accountable for outcomes and increasing the coordination of care. It’s another thing all together in having them take on risk,” she said.

One seat that still remains empty is that of the Office of the National Coordinator for Health Information Technology. Because of this, we probably won’t see any changes to health IT policy until someone is appointed.

Forge ahead

There are still a lot of appointments to be made in Washington before we see how things may shake out, putting us in an uncomfortable place of uncertainty. Millions of clinicians across the country are allocating time and money to prepare for MACRA without knowing how the game may change—or will it? If we have learned anything over the last 10 years it’s that nothing ever seems to be final. Once a rule is finalized, another rule is drafted to either remove or dial back the requirements. So, although it’s too early to know what the next administration will bring, we have no reason to expect that MACRA will go away. The best thing to do is press on until told otherwise.

Editor's Note: The article first appeared on the Acumen Nephrology blog on Feb. 20