WASHINGTON — Members of the next Congress — from both sides of the aisle — will be watching to see whether the Medicare Access and CHIP Reauthorization Act (MACRA) is being properly implemented over the next few years, congressional staff members said here Thursday.
“Making sure MACRA is a success [is important]; we all held hands and jumped on that one,” a Republican congressional aide said at the event, which was sponsored by the Alliance for Health Reform and the Jayne Koskinas Ted Giovanis Foundation for Health and Policy. “We all own it, and it needs to be a success, because this was our effort to take ideas from both sides and say ‘This is how we want to slowly start reforming the Medicare program.'” Staff members at the briefing agreed to be quoted only if they were not identified by name.
“There are plenty of places within MACRA that the committees will have to be engaged in,” he told MedPage Today. “One area we think has great potential is this idea of virtual groups, of allowing small providers to use technology to come together to ease reporting requirements … I think that will be something we’ll kind of check in and say, ‘OK, to what extent are we capable of doing that? Are there things we may need to look at doing further?'”
As the Centers for Medicare & Medicaid Services explains it in a fact sheet, MACRA “provides that solo and small practices may join ‘virtual groups’ and combine their … reporting” under Medicare’s Merit-Based Incentive Payment System (MIPS). “CMS is seeking public comment on how virtual groups should be constructed, and anticipates being able to implement virtual groups in the second year of the program.”
Although some physicians want to use MIPS, which would allow them to stay in the fee-for-service system, others seem willing to try participating in one of the new alternative payment models (APMs), noted a Senate Democratic staff member. However, “providers are nervous about taking on risk, and they want a model that provides incremental steps towards taking risk,” she said. Therefore, it’s important that under a Republican administration “they continue to put out models that provide providers with ‘landing spots’ to engage in APMs.”
The Republican House staff member said he found it “amazing” how far providers have come on this issue in the past few years. “We went from a world of ‘I don’t know what an APM is; I’m scared of it; it’s new; it’s different; I don’t want it’ to now, when you have providers post-MACRA going, ‘I want to be in an APM.’ I don’t want to talk about it too much because I don’t want to spook anybody away, but that’s a significant movement from where we’ve been.”
He spoke in measured tones about CMS’s Center for Medicare & Medicaid Innovation (CMMI), which has been criticized for being too heavy-handed with the demonstration projects it has launched in the physician payment area. “I do think there are legitimate concerns when it comes to CMMI [in terms of] the delegation of congressional authority … I think you can find a balance between the legitimate concerns we have expressed … and realizing there is a need to provide providers with the tools they need to be able to look at ways to transform their practice in a responsible way that does not have them scared away by the risk.”
The Democrats, for their part, will be watching to see if the Republicans’ numbers add up when it comes to repealing the Affordable Care Act (ACA), said a House Democratic staff member. “We will hold folks accountable to their own statements and their own commitments.”
For example, “We’ve heard that the preexisting condition exclusion will be protected. Analyze that carefully, because not all preexisting exclusions or protections look alike … Under what situations can you be charged more, and can you be denied?”
“We’ve also heard a lot about how whatever’s coming will ensure that coverage doesn’t decrease, and coverage may increase … Look at the numbers,” she continued. “How does the distribution change? Who’s gaining coverage? Who’s losing coverage?” One ACA alternative proposed in 2009 by then-House Speaker John Boehner (R-Ohio) covered 3 million new people, and “that’s a big difference from where we are today,” with an additional 20 million people covered under the ACA, she said.
Finally, she said, “How can the underlying subsidies and underlying revenues be repealed, and [the Republicans] still find a way to maintain the same level of support, coverage, and subsidy for the average working family? Part of the health insurance experience is being able to access a doctor, but the other part of it … is financial security.”