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All About MACRA: Four Takeaways from CMS Chief Andy Slavitt’s Speech to the American Medical Association

On Monday, Centers for Medicare and Medicaid Services (CMS) Administrator Andy Slavitt addressed the American Medical Association’s 2016 annual meeting. Slavitt usually leverages such opportunities to send highly specific messages— at the JP Morgan Conference earlier this year, he told an audience of healthcare technology executives that interoperability had to be part of their mandate— and this time was no different. Slavitt told the audience of physicians and physician executives that the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) would be good for them and is worth supporting. Below are a couple takeaways from his remarks:

MACRA is More than the Anti-SGR

MACRA originated as a replacement for the Sustainable Growth Rate, which was a formula that controlled physician payments from 1997 to 2015. The intention behind the SGR was good, it was meant to ensure that physician payments didn’t grow faster than the GDP, year-over-year. But the SGR was widely disliked and useless in practice, as Congress repeatedly updated physician payment protocol to nullify impending SGR cuts.

This is a rather negative origin story for MACRA though, and at the AMA Slavitt focused on a happier one. He noted that MACRA had four intentions: promoting pay-for-value, reducing paperwork time for physicians, making healthcare technology a tool “and not an industry,” and piloting an open process of implementation where the federal government collaborates more with front-line providers.

In other words, unlike past incentive programs like Meaningful Use, which many physicians feel has enriched EHR companies while forcing them to use a weak product, MACRA prioritizes physicians’ needs. It’s more than just the SGR’s substitute.

CMS Shifting from Selling MACRA to Operationalizing It

A CMS speech from six months ago may have stopped there and not gone further. In fact, Slavitt usually sticks to talking in broad strokes about MACRA’s objectives. But on Monday, Slavitt went into greater detail on the MACRA incentives themselves. He focused almost entirely on payment specifics, telling physicians exactly how their pocketbooks would be affected, noting that MACRA reduces the potential downward adjustment of CMS incentive programs and includes new bonus payments.

This level of detail might signal that CMS is ready to stop selling the law to physicians and finally move on to operationalizing it— just in time, as the first reporting period starts next year.

Slavitt promised that CMS would publish new information to better explain these details, including webinars, fact sheets, and web portals, perhaps nodding to what many physicians have been saying about MACRA— they’re confused.

CMS Seeking to Make MACRA Reporting Easier than it Was Under PQRS/VBM/MU

Documentation and reporting has been one of the toughest parts of the existing Medicare incentive programs, largely because there are three different Medicare incentive programs that each require individual reporting: the Physician Quality Reporting System, the Value-Based Payment Modifier, and Meaningful Use.

In contrast to current reporting, Slavitt said in his speech that QPP reporting would be simple and inexpensive.

He highlighted several ways in which this will happen. CMS will allow reporting from multiple sources, increase the number of items that can be reported under attestation, eliminate duplicate reporting, and use automatic data feeds like claims when possible. Physicians can also use a variety of mediums to report, like certified EHRs, clinical data registries or other sources which CMS can access.

These are a lot of concessions, yet they were not enough for small practices, who are still worried that documentation will be unduly hard for them. During the Q & A session after this speech, a coalition of nine medical societies asked Slavitt if CMS would consider a special transition period for small practices. He didn’t respond definitively, but given the Department of Health and Human Service’s overall focus on strengthening small practices, this is a plausible future policy change.

CMS is Already Thinking About Potential MACRA Changes

Slavitt noted that he had already received a great deal of feedback on MACRA, and that as it was used more it would change and adjust.

Two future priorities he singled out were one, to put pressure on technology vendors. Interoperability, open APIs, and eliminating “desktop locks,” were three issues Slavitt singled out.

The second priority was customization. Slavitt mentioned increasing the specification of MACRA quality measures, working closely with specialty societies, many of whom already have quality metrics for their members.

By giving time to these, he may have been both setting expectations for MACRA to change in the future, for those who like the program as-is, and also reassuring skeptical physicians that MACRA would change in the future.

Bringing Physicians On Board is Crucial

If all this sound like it makes for a very heavy speech, it’s because it was. Physicians are a crucial constituency that must be on board, if MACRA incentives are to work, and CMS took a shot at accomplishing that this week.

 

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