Senate Told CMS May Put Off Implementing MACRA
Written by Editor   
Thursday, July 21, 2016 12:00 AM

The Centers for Medicare & Medicaid Services (CMS) might be open to delaying the implementation of parts of the SGR repeal law dealing with physician payment, CMS acting administrator Andy Slavitt told the Senate Finance Committee. ”We remain open to multiple approaches. Some things on the table include alternative start dates, looking at whether shorter [reporting] periods could be used, and finding other ways for physicians [to get used to] the program before the impact really hits them."

Several committee members expressed concerns about how MACRA will impact small and rural practices. "We recognized the inherent challenges of these types of practices when we crafted MACRA," said committee chairman Orrin Hatch. "I know CMS is aware of the issue but we need to make sure ... these practice settings remain viable options for Medicare beneficiaries."

"Our focus on small independent practices and their ability to practice independently is a very high priority for us," Slavitt said. " And any practice that practices in a rural location has a very different set of dynamics than other practices do. Often in small practices you'll find it's a physician and their spouse and that's all the work they do ... So additional paperwork [time] comes out of patient care.”  CMS is looking at issues such as "How do we compare the performance of small physician practices? How do we lessen the burden?" he continued. He noted that the agency just adjusted the way it reimburses physicians who participate in the Medicare Advantage program to account for these types of differences. 

"One thing that's really important to us is to get out of the mode where physicians feel they're just going to cut, test, and prescribe to patients, [and instead can talk] about how the patients are managing the chronic conditions they're living with," Slavitt replied. "So [we're encouraging] models like medical home models, which provide a care coordination fee so small practices ... can invest in things to call patients at home, check on how they're doing, and make sure they're taking their medications ... The more these advanced models are part of MACRA, the more successful they're going to be."

The failure of 16 of the 23 health insurance co-ops that were opened under the Affordable Care Act was another concern of the Senate panel. "It looks like 70% have already failed; I'm told to expect more failures," said Sen. Pat Toomey.

This is to be expected in a brand new market with a new set of rules. They have to make adjustments." He said that CMS was looking over the June financial reports of the remaining co-cops, adding that "Our priorities are two-fold: to make sure consumers taken care of as best as possible [and] to look responsibly after the capital that has been committed."