ASCO Submits Comments on Proposed MACRA Implementation Rule

CMS Urged to Allow Adequate Time to Prepare for "Seismic" Changes Under Law
June 28, 2016

The American Society of Clinical Oncology (ASCO) submitted comments on the Centers for Medicare & Medicaid Services (CMS) proposed rule published in the Federal Register on May 9, 2016, to implement the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). In its comments, ASCO urges CMS to allow stakeholders enough time to prepare and report correctly in January 2017.  

"The rules governing the seismic changes brought about by MACRA are unlikely to be finalized until late this fall," said ASCO President Daniel F. Hayes, MD, FASCO, in the statement. "Basic notions of fairness dictate that CMS should delay the initial implementation of the performance period to allow providers a chance to reorganize their practices to succeed under the new regulatory standards."

Instead of the full year reporting requirement that CMS proposed for 2017, ASCO's comments strongly urge CMS to delay implementation of the reporting requirements for the quality performance category until July 1, 2017, to alleviate the new regulatory burdens brought about by MIPS implementation.

In its comments, ASCO also made recommendations regarding the two major paths for physician reimbursement within MACRA, the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) including Physician Focused Payment Models, as well as data transparency.

Merit-based Incentive Payment System

Many, if not most, oncologists will start in MIPS, the default Medicare physician payment system under MACRA, and transition to APMs over time. ASCO's comments on MIPS fall into four categories: quality reporting, resource utilization, clinical practice improvement activities (CPIA), and meaningful use of certified electronic health records:

  • Quality Reporting - ASCO supports the use of Qualified Clinical Data Registries (QCDRs) and has offered the Quality Oncology Practice Initiative (QOPI), a cancer-specific designated QCDR, for more than a decade. ASCO also asserts that QCDR-developed quality measures should not be subject to the proposed additional CMS verification processes before the measures can be used for MIPS reporting. 
     
  • Resource Utilization - ASCO recommends that CMS exclude the costs of cancer drugs from the measures for resource use under MIPS unless CMS implements an adequate risk adjustment system that takes into account the cancer type, cancer stage, and molecular subtype. Oncologists have little or no control over drug prices, and in many instances, a single molecular entity provides a clear clinical advantage for a particular patient without another drug providing a clinically equivalent substitute. 
     
  • Clinical Practice Improvement Activities (CPIA) - ASCO urges the inclusion of QOPI certification on the list of CPIAs. 
     
  • Meaningful Use of Certified Electronic Health Records - The proposed rule renamed the current Meaningful Use program for evaluating electronic health record (EHR) usage to the Advancing Care Information (ACI) program. ASCO asserts that ACI would offer some improvements over the Meaningful Use program, but widespread interoperability in the health information technology ecosystem is needed before providers can be fairly evaluated for their EHR use.

Alternative Payment Models (APMs)/Physician Focused Payment Models

Participation in an Advanced APM will allow physicians to opt out of MIPS and receive an additional financial bonus over and above what is negotiated for any specific model. ASCO urges CMS to take a more flexible approach toward inviting and adopting oncology-focused medical homes and APM models developed in the private sector.

ASCO also urges the Administration to make full use of alternative channels created by Congress to speed progress toward innovative payment models. The newly formed Physician Focused Payment Model Technical Advisory Committee (PTAC) offers specialty societies, like ASCO, an important public forum to vet and refine their concepts for creating physician focused payment models (PFPM) for implementation as APMs.

ASCO spent years developing a PFPM for oncology, the Patient-Centered Oncology Care (PCOP) model, that the society believes offers an important alternative to the Center for Medicare & Medicaid Innovation's (CMMI) Oncology Care Model (OCM). According to ASCO, CMS should create a clear pathway for models that are recommended by the PTAC to be implemented in a timely manner.

Data Transparency

As part of its efforts to improve transparency in the Medicare program, CMS aims to release more data for stakeholders to understand and analyze the impact of changes in Medicare policies.  ASCO strongly supports these efforts and offers recommendations for CMS to aid physicians seeking to project the impact of MIPS, APMs, and other MACRA provisions. 

In particular, the society believes that a 100 percent version of the Standard Analytic File (SAF) containing physician claims should be released as a limited data set to allow researchers to better assess CMS proposals regarding MACRA and to improve the ability of ASCO and other stakeholders to interact with CMS about the policies being implemented under MACRA, as well as advancing other policies to improve and modernize Medicare. 

"ASCO has partnered closely with Congress and CMS in the development and implementation of MACRA," said Dr. Hayes. "We urge CMS to continue to work closely with ASCO and other stakeholders throughout the implementation process to ensure adoption of a fair, transparent and adequate reimbursement methodology for oncologists and other physicians."

In submitting these comments, ASCO notes that MACRA implementation comes at a time when CMS has proposed an experiment on Medicare Part B that will, effectively, remove resources from practices as they prepare for sweeping changes under MACRA. This could disrupt the site of care for Medicare patients with cancer, work against the goals of MACRA, and increase the costs to the system overall. ASCO opposes the CMS Part B proposal.

ASCO's statement is now available in its entirety. Throughout the MACRA implementation process, ASCO will share the latest updates and information at www.asco.org/macra. For an explanation of MACRA’s frequently used terms, please visit the Medicare Reimbursement Reform Glossary.  

ASCO in Action