On June 22, 2023, the Energy and Commerce Subcommittee on Oversight and Investigations held a hearing to conduct oversight on the implementation and effectiveness of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which aimed to shift the focus from volume, or quantity, to value, or quality, in health care.
As original supporters of the passage of MACRA and physician-led payment reforms, the Alliance submitted a statement to the subcommittee outlining suggested actions that Congress should take to stabilize the Medicare physician payment system while ensuring successful value-based care incentives are available for specialty physicians. The Alliance remains concerned about structural challenges and instability in Medicare payments to physicians and urged the oversight subcommittee to work with the committees of jurisdiction to begin the process of stabilizing and improving Medicare physician reimbursement and performance programs through legislative reforms.
In its detailed statement, the Alliance presented several options for Congress, including:
- Replacing flat base payment updates (in CY 2024 and 2025) and improving nominal base payment updates (in CY 2026 and beyond) with annual payment updates to the Medicare conversion factor that are based on an appropriate inflationary index that reflects rising practice costs, such as the Medicare Economic Index (MEI);
- Exempting the following from budget-neutrality adjustments:
- Newly-covered or expanded Medicare benefits, items, and services, such as preventative services and new technologies,
- Items and services that are delivered in response to a public health emergency (PHE) and,
- Changes in relative values due to increased practice costs (e.g., clinical labor, professional liability);
- Authorizing the Secretary of Health and Human Services the flexibility to waive or modify budget neutrality requirements in other circumstances, as appropriate;
- Requiring ongoing and consistent updates of key data inputs used to set Medicare payments to physicians (e.g., practice expense and liability insurance) and holding physicians harmless from these updates, which are outside their control;
- Evaluating the impact of the Quality Payment Program (QPP) and Physician-Focused Payment Model Technical Advisory Committee (PTAC) on health care quality and value, as well as access to care— particularly as it relates to specialty care;
- Making technical improvements to MACRA to strengthen the Quality Payment Program (QPP) and the Merit-Based Incentive Payment System (MIPS)
Click on the link below to access the entire statement.
Alliance Statement to O/I Subcommittee MACRA Hearing
Also, in late October 2022, the Alliance responded to a Request for Information (RFI) on actions that Congress should take to stabilize the Medicare payment system while ensuring successful value-based care incentives are in place. The RFI was issued by a bipartisan group of Congressional leaders asking for feedback on the effectiveness of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, which repealed the sustainable growth rate (SGR) formula and expanded the role of value-based payments under Medicare, as well as recommendations on regulatory and statutory solutions to improve provider participation in value-based programs and models.
The Alliance’s response focused on actions to improve Medicare physician payment updates, such as incorporating an inflationary index in the Medicare conversion factor to reflect rising practice costs and exempting certain costs from budget neutrality requirements. The Alliance also requested that Congress evaluate the impact of the Quality Payment Program (QPP) and Physician-Focused Payment Model Technical Advisory Committee (PTAC) on healthcare quality and value, as well as access to care — particularly as it relates to specialty care. Finally, the Alliance outlined numerous technical improvements to strengthen meaningful specialist participation in the Merit-Based Incentive Payment System (MIPS) and alternative payment models (APMs). The letter can be accessed by clicking the link below.
