There is considerable uncertainty in the federal healthcare policy arena right now, with a new president and administration, and the new president’s Health and Human Services Secretary-designate not yet confirmed by the U.S. Senate. What’s more, Rep. Tom Price, the Georgia Republican whom President Trump has chosen to lead HHS, is both a former practicing physician (he practiced orthopedic surgery in the Atlanta area for over 20 years), has been one of the most active members of the House of Representatives in terms of healthcare legislation and regulation in the two years he has served in the House, as a fiery opponent of the Affordable Care Act (ACA) and of what he has called excessive healthcare regulation.
What might happen in the next two years in terms of federal healthcare legislation and regulation, as well as the current complexities around quality reporting requirements under the MIPS (Merit-based Incentive Payment Program) and under the APMs (alternative payment models) framed by the MACRA (Medicare Access and CHIP Reauthorization Act of 2015), will be the subject of a presentation at the MGMA 2017 Financial Management and Payer Contracting Conference, sponsored by the Englewood, Colo.-based Medical Group Management Association (MGMA), and held Feb. 19-21 in Las Vegas. On Monday morning, Feb. 20, Jennifer McLaughlin, senior associate director for governmental affairs at MGMA, will present on the topic of “The Evolving Medicare Payment Landscape.” As the conference’s program description explains it, “With implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) underway, physician practices are assessing the two new pathways for Medicare payment—traditional fee-for-service coupled with a quality performance bonus or penalty under the new Merit-Based Incentive Payment System (MIPS) and risk-based alternative payment models (APMs). This timely session will review the key details of MIPS – which replaces PQRS, meaningful use and the Value-Based Payment Modifier – and APMs.”
Recently, the Washington, D.C.-based McLaughlin spoke with Healthcare Informatics Editor-in-Chief Mark Hagland about the present moment in federal healthcare policy, and how she and her fellow advocacy leaders at MGMA, which represents 350,000 physicians practicing in 18,000 patient care organizations, see the policy challenges and opportunities going forward for their association’s member medical groups. Below are excerpts from that interview.
What are you basically going to be talking about in your presentation at this month’s upcoming conference, in terms of policy and payment?
I’m really going to be a drilling down on some of the questions around MIPS and MACRA, and addressing some of the questions that our members should be considering. And acknowledging that most participants will be in MIPS at the beginning, we will look at all the different MIPS quality scores and drill down, and look at some of the APMs on the table that practices need to know. And I’ll start by looking at the broader landscape around value-based care delivery and payment that’s not going away. And there may be some changes with the new administration, and will provide some perspectives on that.
So essentially, you believe that MACRA and MIPS will largely be left alone by the new Congress?
It’s hard to know without a crystal ball whether any of these programs might be impacted by any broader policy changes? But I agree, MACRA was bipartisan and separate from the ACA. And this move towards value-based payment has been going along for a long time, and I don’t see them being changed on a broad level. Largely, where we see some issues will be on the APM side, in terms of the risk definitions, and definitions of qualitied participant organizations.
Do you see any wholesale changes to MIPS being made?
Anything is on the table, given Rep. Price’s role and leadership in enacting MACRA. His intimate knowledge of the program increases the chances that we may see some wholesale changes. Last year, we were asked to present a number of changes prior to the final legislation. Price was there at the meeting at the beginning of October of what’s called the “Doctors’ Caucus”—an informal group of about 18 to 20 members of the House who are physicians. They invited a number of medical associations and physician specialty groups regarding physicians’ concerns about MACRA. This was just before the final rule came out on October 14. So this was at the beginning of October. And Rep. Price was fully engaged in overseeing the policy, and even in the weeds at that moment. So he comes in with an unprecedented understanding of how this law is being implemented; so really, anything is on the table.
But they wouldn’t overturn MACRA, because they’d have to put that SGR money back?
That’s right. And any changes that might be made to MACRA/MIPS would probably go into effect in 2018 and in subsequent years, not this year.
So, to be clear, you don't believe that MACRA will be overturned by Congress?
That's right.
Is it a possibility that the number and rigor of MIPS quality measures might be drawn down?
I don’t know what’s being floated, but we’ve asked for an extension of the pick-your-pace flexibility announced for this year. We’ve asked for a harmonization across programs, because it still feels somewhat siloed. If a practice is reporting their clinical measures through a registry with their EHR [electronic health record], extracting that data through their EHR, and through that, demonstrating that not only are they using the registry to collect and analyze their clinical quality data, but engaging their EHR to be able to submit their data to the registry, we haven’t heard a reason why they couldn’t get credit across multiple categories under MIPS. There are four categories in MIPS: quality, advancing care information, practice improvement activities, and cost (though cost isn’t being measured this year).
So whatever reporting physicians are going to do, you’d like for them to get credit across several of these categories?
Yes. There is this idea that Rep. Price has that some of these regulations are interfering with the physician-patient relationship and with the ability of physician practices to become as efficient in their care delivery as they could be.
What are your concerns around APMs and what might happen with APMs?
Well, the area where we certainly appreciated Rep. Price’s oversight was with regard to the mandatory bundles—we agree with Rep. Price that we don’t believe that either bundle should be mandatory from CMMI, Center for Medicare and Medicaid Innovation within the Centers for Medicare and Medicaid Services]. The total joint replacement and cardiac care bundles start with the hospital. And there’s a Part B regulation that would have changed the way Medicare pays for Part B drugs—certain practices and other facilities would be impacted. It would have changed the billing reimbursement for those Part B drugs. That was proposed last year, and we submitted comments. And Rep. Price had asked the chair of the House Budget Committee to consider this, and he held an oversight hearing on how this might be rolled out, and the unintended consequences it might have on access to those drugs. That’s where we saw a preview of what we might see n his role as HHS Secretary, which might be to shift these CMMI models towards voluntary.
In terms of the rumor that’s been floating around Capitol Hill that Rep. Price, once he becomes HHS Secretary, will try to get rid of CMMI—what do you think will happen, and do you have a position on it?
It’s hard to predict what will happen, but we do think that our position would align with that of the incoming administration, in that we think that there are opportunities to shift the top-down approach that CMMI is currently taking. We think that there are models being created under the Medicare Advantage that could leverage the data it has to help practices participate in models that are already ongoing. The results, and even some of the data analytics in those models, haven’t been as comprehensive as they could have been. We would want to see CMS move away from its top-down, heavy approach.
But you don’t believe that the CMMI should be abolished?
We don’t have a position on that, just on the strategies it might pursue.
You haven’t supported the total repeal of the ACA, right?
We have not come out one way or another. We have expressed our interest in working with the new Congress and new administration as they work through the policy alternatives to the ACA. But we’re waiting to see what’s on the table.
There’s a huge component of internal health system reform involved in the ACA. What might happen to that large component of the law?
Our understanding is that wholesale repeal of all of those pieces is unlikely to happen through reconciliation. So we are just looking forward to, once that dialogue does begin as to what the legislative package starts to look like, we look forward to providing input on how Congress can capitalize on that bipartisan initiative to repeal the SGR and create MACRA, and help to reduce excessive regulation, and support business-friendly policies. But at this point, we don’t see too many of those issues being impacted through the reconciliation process.
What are your members telling you about this current healthcare legislative situation and environment?
As far as the regulatory environment goes, we’re seeing a lot of requests for clarification on MACRA from CMS. What we’ve been seeing since October 14 is clarification for practices on how they can comply and also leverage it as part of broader healthcare quality improvement activities. We see tremendous interest in simplifying the MIPS requirements.
Do you have any thoughts on where Seema Verma might be headed as CMS Administrator?
I cannot comment on that.
What do you think will happen overall in the next year or two?
It’s hard to know without a crystal ball; I don’t want to make any predictions at this point. But we’re looking forward to being at the table, making improvements to the healthcare system, mitigating the burden on medical group practices, and helping to provide high-quality, effective care across the whole country.
