Testifying before the Senate Finance Committee yesterday, CMS Acting Administrator Andy Slavitt told committee members that the agency is considering the possibility of delaying the Medicare Access and CHIP Reauthorization Act (MACRA) until next January. 

The hearing was held to examine the CMS implementation of MACRA.

In testimony before the committee, Slavitt said MACRA, which replaced the Sustainable Growth Rate (SGR) formula, was “a more consistent way for paying physicians and other clinicians, provided new tools to modernize Medicare and simplify quality programs and payments for these professionals.” 

Slavitt also reminded lawmakers that Medicare measures the value and quality of care provided by physicians and other clinicians through what he described as “a patchwork of programs,” noting that clinicians are part of APMs such as Accountable Care Organizations (ACOs), the Comprehensive Primary Care Initiative, and the Bundled Payments for Care Improvement Initiative. He also said that most (physicians) participate in the Physician Quality Reporting System, Physician Value-based Payment Modifier (Value Modifier Program), and the Medicare Electronic Health Record (EHR) Incentive Program.

“Thanks to Congress, MACRA streamlined these various programs into a single framework where clinicians have the opportunity to be paid more for providing better value and better care for their patients,” Slavitt said. “CMS has proposed to implement these changes through the unified framework called the Quality Payment Program.”

The impact of MACRA on rural healthcare was evident at the beginning of yesterday’s hearing when Senate Finance Committee Chairman Orrin Hatch (R-Utah) acknowledged the plight of rural hospitals.

“I want to flag an important concern that I know is shared by others,” said Hatch, “which is the plight of small and rural physician practices. We recognized the inherent challenges of these types of practices when we crafted the MACRA statute and I know CMS is aware of these issues, but we need to make sure that the law is implemented in a way that works for these physicians and ensures that these practice settings remain viable options for Medicare beneficiaries.” 

Indication that CMS was considering the possibility of delaying MACRA came in this exchange between Hatch and Slavitt. 

Hatch: “Physicians are concerned that they won’t have enough time to prepare…this seems to be a legitimate concern. The MACRA law gives CMS flexibility to the start of physician reporting period. What options is CMS considering to make sure this new program gets off the right foot?”  

Slavitt: “You’re exactly right. I want to begin where you ended. We need to launch this program so that it begins on the right foot. And that means that every physician in the country needs to feel like they are set up for success.  So this has been a significant source of feedback that we’ve received as well. And I would start by saying that we remain open to multiple approaches. So some of the things that are on the table, we’re considering, include alternative start dates, looking at whether shorter periods could be used, and finding other ways for physicians to get experience with the program before the impact of it really hits them.”

In closing remarks, Slavitt acknowledged the burden facing physicians treating the Medicare population. 

“We should remember that physicians have many frustrations and challenges with the current health care delivery system, and the implementation of this law will not resolve these overnight. We will continue to need real and direct feedback from physicians, clinicians, beneficiaries—and from you and the rest of the Congress—on what is working and what should be adjusted,” Slavitt said. “The launch of this program is only the first step in a larger process.” 

About the Author

Chuck Buck is publisher of RACmonitor and is the executive producer and program host of Monitor Mondays. 

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