On March 21, the House Ways and Means Subcommittee on Health held a hearing focused on the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The event was mostly a question and answer session along with introductory remarks from invited panel members. This included Demetrios Kouzoukas, the Principal Deputy Administrator for CMS, and Dr. Kate Goodrich, Chief Medical Officer at CMS.
Discussion
The discussion was wide ranging and touched on a number of issues. Regarding bundled payments, Rep. Levin raised concerns about CMS moving away from value based care after the agency scaled back CJR bundled payments. Rep. Johnson asked if social security numbers from Medicare cards are on track, which CMS confirmed is the case. Rep. Thompson asked when the CMS vision of interoperability will be achieved, and CMS noted it is still working on the issue. The agency highlighted its work on reducing regulatory burden as being helpful in this particular area.
On the topic of administrative burdens, Rep. Smith offered general comments and CMS described the problem as very real and not an abstract concept. Physicians are buried in their electronic records and it takes away from patient care. CMS said they have acted on administrative burden issues in prior rules such as raising the low volume threshold for MIPS and creating virtual groups.
Regarding APMs, Rep. Jenkins encouraged CMS to allow more one sided risk models to share in APM incentive payments, although CMS has been resistant on this issue in the past. Rep. Chu described having the first all-inclusive ACO payment model in her district. She highlighted a secondary payer problem in the model and asked for CMS to ensure that payment errors do not occur in the future. Rep. Kind asked about CMS goals for APM participation. There was a 50% goal under the former administration. CMS was non-committal, however, about a specific number, yet the agency still wants to move toward higher value based care percentages.
Rep. Marchant continued by raising the issue of Stark laws, highlighting the need to reform the laws in light of value based care. Rep. Kind also described the need to address the rising costs of medication and CMS said it has put out some ideas and will be working to address the issue. Rep. Paulsen brought up risk issues in MACRA and specialty specific measures. CMS said MACRA gives the agency resources to develop quality measures and said they recently announced opportunities in this area to encourage the development of these types of measures. The agency also highlighted its “patients over paperwork” initiative. Additionally, regarding small practices in APMs, CMS said it is working to develop many APMs and they realized there cannot be a one-size-fits-all approach. In the future, there will be a way to count private/MA APM participation under MACRA.