October 17, 2016
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AAFP, AMA, AMGA, ACP respond to MACRA finalization

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Medical groups are weighing in on HHS and CMS finalizing a policy on the Medicare Access and CHIP Reauthorization Act Quality Payment Program.

Leaders of the American Academy of Family Physicians (AAFP), American Medical Association (AMA) American Medical Group Association (AMGA) and the American College of Physicians (ACP) felt the act, known as MACRA, addresses many of their suggestions, but that there is still work that needs to be done.

“We are pleased that practices with low volumes of Medicare Part B patients are excluded in the first year and that family physicians will be able to move toward full participation without suffering penalties that will slow their progress,” John Meigs, Jr., MD, president of AAFP, said in a press release. “We’re particularly pleased the rule implements and provides additional clarification regarding the ‘pick your pace’ program that allows practices to choose their reporting timeline for participating in the MACRA Quality Payment Program.”

Meigs added that this component of the program, and several other “flexibilities” will benefit small, solo and low-volume practices. In the same statement, Meigs said AAFP still needs to hear from CMS on some of its suggestions, but that most of its comments were addressed by CMS.  

Both AMA and ACP were appreciative of HHS and CMS willing to acknowledge input from clinicians. 

“The AMA acknowledges the commitment by [HHS and CMS] for listening to physician concerns and taking several concrete steps to help them adjust to this new Medicare payment framework,” Andrew W. Gurman, MD, AMA President, said in a press release. “Our initial review indicates that CMS has been responsive to many of the concerns raised by the AMA and in the days ahead, the AMA will conduct a comprehensive review of the final rule to ensure that it promotes flexibility and innovation in the delivery of care to help meet the unique needs of all patients … [T]he new law gives many physicians the opportunity to be rewarded for the improvements they make to their practices and for delivering high-quality, high-value care to Medicare patients.”

AMGA shared HHS’s idea behind the premise of MACRA, but also felt there were some limitations to the plan.

“Ultimately, MACRA is about moving the health care system toward one that is based on quality and value, a goal that AMGA shares with [HHS] as well as the Congress,” Donald W. Fisher, PhD, CAE, president and CEO of AMGA said in a press release. “We remain concerned, however, that in its understandable desire to provide flexibility, particularly as the program begins, CMS does not adequately recognize or reward the providers and systems who have made the investments to improve quality and decrease costs. We believe rewarding performance should be based on the value provided, not on size of the practice.”

ACP also acknowledged the benefit of the ‘pick your pace’ option, the increased low-volume threshold for participating in MIPS, expanded options for patient-centered medical homes, the new Medicare Shared Savings Program Accountable Care Organization and adjusting resource use, but also thought the plan that was finalized doesn’t go far enough.

“[We] will review the rule in greater detail, but expect to be asking for improvements in several areas.  In particular, we would like to see CMS provide multiple pathways for medical homes, beyond CPC+ within the advanced APM pathway,” Nitin S. Damle, MD, MS, MACP, president, ACP said in a press release. “ACP is committed to working with CMS to ensure that the MACRA program truly results in a healthcare system that puts patients, families, and the relationship of patients and families with their physicians at the forefront.

Under the new payment system, clinicians can choose the pace with which they will participate in the transition from a fee-for-service health care system to one using alternative payment models rewarding quality care over quantity of service. AMA unveiled some tools to help physicians with MACRA earlier this month.

Editor’s Note: this has been updated to include comments from ACP.

Additional reading:

http://www.aafp.org/media-center/releases-statements/all/2016/MACRA.html

http://www.ama-assn.org/ama/pub/news/news/2016/2016-10-14-cms-final-medicare-macra-rule.page

http://www.amga.org/wcm/AboutAMGA/News/2016/20161014.aspx

https://www.acponline.org/acp-newsroom/the-american-college-of-physicians-statement-on-the-macra-final-rule