Experts from ACP discuss MACRA H.R. 2, shift to value-based payments post-SGR

BOSTON — During a press conference at the American College of Physicians Internal Medicine Meeting, internists discussed key components of the Medicare Access and Chip Reauthorization Act H.R. 2 and its implications for clinical practice.

The MACRA H.R. 2 was approved by the House of Representatives on March 26 by a vote of 392 to 37, and was approved by the Senate on April 14 by a vote of 92 to 8. The legislation was signed by the president on April 16. It nullifies the Medicare Sustainable Growth Rate (SGR) and replaces the 21% reduction in physician payments implemented under the SGR. Under the new legislation, Medicare will transition from volume-based provider payments to value-based payments.

According to Robert B. Doherty, senior vice president of governmental affairs and public policy for the ACP, MACRA H.R. 2 has the support of more than 750 physician organizations ranging from surgery to primary care.

“I have never seen medicine more unified at any other time on any other issue,” Doherty said at the press conference. “To be unified on repealing SGR was easy, but to be unified in support of transitioning physicians away from [volume services to value-based payments] was a big move for organized medicine.”

Beginning in 2019, physicians will be able to choose between earning performance-based incentive payments either through a new Merit-based Incentive Payment System (MIPS) or an Alternative Payment Model, such as a patient centered medical home.

“In 2019, there will be a fork in the road, and physicians will have to choose,” Doherty said.

Shari M. Erickson, MPH, ACP’s vice president of governmental affairs and medical practice, discussed the work that lies ahead for the ACP in ensuring the legislation is properly executed, and that ACP’s 141,000 members will be prepared for it.

“Moving forward, ACP will be very engaged in influencing CMS on implementation of the law, to ensure that it stays true to its intent of significantly improving the Medicare physician payment system,” Erickson said in a press release. “Additionally, ACP will make it our top priority to ensure that our members are fully informed about and prepared for active and successful participation in the newly established Merit-based Incentive Payment System or an Alternate Payment Model.”

Erickson said that MACRA H.R. 2 will align quality reporting programs, such as Physician Quality Reporting System (PQRS), Meaningful Use and the Value Based Modifier Program, which had previously been separate.

“For the next four and a half years, this current PQRS and Meaningful Use and Value-Based Modifier program models will need to evolve and improve, and they are going to be shared and merged together,” she said. “So the rulemaking for the next 4 years is going to be crucial on each of these programs. It will involve CMS and the Office for the National Coordinator for Health IT (ONC), and likely other agencies within HHS to work closely on this rulemaking, to take this outline that is laid out and implement it.”

ACP president-elect Nitin S. Damle, MD, MS, MACP, a founding partner of an eight-physician private practice in Rhode Island, said his practice adopted EHR in 1997, transitioned to a patient centered medical home model in 2010, and has participated in Meaningful Use and PQRS since the inception of these programs.

“We have a typical internal medicine practice: 50% of our patients are over age 65, and we cover a spectrum of diagnoses — diabetes, hypertension, acute and complex conditions,” he said. “Moving forward, we’re going to need to be ahead of the curve in terms of what’s happening to our patients, how we’re being measured and how we care for our patients.”

He said in repealing the SGR, the new legislation will ease physician and patient concerns about Medicare and Medicaid participation due to “double-digit decreases” in physician payments.

“As physicians, we had to ask ourselves, what would we do if there was a 23% or a 21% cut in payments? What would we opt out of?” Damle said. “That’s a difficult decision, considering that about 50% of our patients are older and are on Medicare, and we take care of their chronic problems. What would they do if they didn’t have access to care?”
Damle said the new legislation will provide a more stable payment system, allowing physicians to improve care while reducing costs. He said this can be achieved by continued adoption of the patient centered medical home model, performance measurement and reporting, and cost accountability.

“I think with the repeal of SGR, this new program we’re putting into place certainly offers us some new opportunities moving forward,” Damle said. – by Jennifer Byrne

Disclosures: Damle, Doherty and Erickson report no relevant financial disclosures.