AAFP urges CMS to simplify implementation of MACRA

The AAFP sent CMS a letter with suggestions on what to remove and what to improve regarding the Medicare Access and CHIP Reauthorization Act, or MACRA, in order to make it easier for physicians to comply.

“Unfortunately, family physicians are facing a regulatory environment that is distracting them from their core purpose to care for their patients,” wrote Wanda Filer, MD, MBA, board chair of the AAFP. “While many industries face heavy regulatory burdens, it is difficult to imagine any industry that is more regulated than the practice of medicine. And to this point, there is not a single discipline of medicine that faces greater administrative and regulatory burden than family medicine and other primary care physicians.”

The letter specifically asked CMS to:
•eliminate the administrative claims population health measures;
•remove all documentation guidelines for management and evaluation codes for primary care physicians in both the Merit-based Incentive Payment System and the advanced alternative payment model pathways;
•strike the Merit-based Incentive Payment Systems and alternative payment models;
•strip size restrictions that confine advanced alternative payment model participation in medical home models; and
•take back the financial risk standards from its definitions of the medical home model.

The Academy also requested modifications to the following areas:
•advanced alternative payment models and these models’ incentive payment arrangements;
•advancing care information;
•CME relative to the improvement activities category;
•coding recommendations;
•data completeness criteria and proposed percentage acceleration;
•improvement activities scoring process;
•Merit-based Incentive Payment Systems performance scores; and
•quality measures.

“The implementation of MACRA will impact our health care system for years to come, and it must be done thoughtfully, carefully, and as simply as possible,” Filer wrote. “The AAFP sees a strong and definite need for CMS to step back and reconsider the current approaches to MACRA, which we view as overly complex and burdensome to physicians. Given the significant complexity of these programs, we strongly encourage CMS to follow the AAFP’s recommendations by which CMS can better align the requirements with the goals and intent of the legislation.”

AAFP cited a recent study that indicated physicians reported spending nearly 50% of their in-office time on administrative and electronic health record-related work and only 27% on direct patient care as evidence why MACRA must be simplified.

Earlier this year, the Academy sent President Donald J. Trump a letter asking him to reduce some of the regulatory burden family physicians face, such as reducing prior authorizations, having CMS use the “core measure sets” created by the Core Quality Measures Collaborative in all federal programs and demonstrations and also having CMS streamline programs and use universal criteria regarding “inconsistent” claims.

In addition, a study unrelated to AAFP’s request to CMS suggests that although the amount of time physicians allocate to desktop medicine almost mirrors the amount of time spent with patients, this time is often not reflected in reimbursement structures.

References: AAFP Presses CMS to Make MACRA Easier on Physicians (accessed 05-01-17)

Disclosure: Filer is board chair of AAFP.