Congress Should Take Action to Improve MACRA Implementation, Organizations Urge

June 14, 2019

ASCO joined more than 120 other organizations in signing on to a letter urging Congress to introduce several improvements to ensure the continued success of efforts to implement the Medicare Access and CHIP Reauthorization Act (MACRA).

In the letter, the organizations ask Congress to take action on several priority issues, including:

Implement Annual Positive Payment Updates – When enacted, MACRA included modest positive payment updates in the Medicare Physician Fee Schedule but it left a six-year gap from 2020-2025 during which there are no updates at all. Following this six-year freeze, the law specifies physician payment updates of 0.75 and 0.25 percent for physicians participating in Advanced Alternative Payment Models (APM) or the Merit-based Incentive Payment System (MIPS), respectively. According to a recent Medicare Trustees Report, these scheduled physician payment amounts are not expected to keep pace with increases in physicians’ costs. The letter urges Congress to replace the upcoming physician pay freeze with a stable and sustainable revenue source so that physicians can continue to provide high-quality care to Medicare beneficiaries.

Extend the Advanced APM Incentive Payments – To help physicians transition into more innovative payment models and account for the significant investment in new technologies, workflow systems, personnel, and training required, MACRA provided a five percent incentive payment for physicians who participate in Advanced APMs for the first six years of the program. However, since there were a limited number of Advanced APMs available, the program was not as well-utilized as expected. The organizations ask Congress to extend the payments for an additional six years to continue to encourage physicians to move into APMs once they become available.

Implement Technical Improvements – The organizations also proposed technical corrections to MACRA including:

  • Simplify MIPS and make reporting more clinically meaningful for physicians
  • Allow CMS to develop multiple performance thresholds, such as one for small and rural practices, to ensure a level playing field for all physicians
  • Exclude Part B drug spending from calculations of APM financial risk
  • Allow physicians to use certified electronic health record technology (CEHRT), health information technology that interacts with CEHRT, or a qualified clinical data registry to achieve interoperability
  • Remove the total cost of care measure mandate, which is flawed and risks holding physicians accountable for costs that are outside their control, such as drug prices.

Read the full letter.