When Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services (CMS), testified before an influential congressional committee Wednesday about implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), the focus was clear: The patient and physician must be at center of the new Medicare payment systems.
Rep. Pat Tiberi, chairman of the U.S. House Ways and Means Committee, said the committee called the hearing to discuss how the draft regulations released last month match the congressional intent of the law. In particular, the committee was interested in how physicians and other stakeholders have responded to the draft regulations. They also focused many of their questions and remarks on the importance of final regulations that take special care to ensure the success of physicians in small practices, as well as those in larger groups.
“MACRA streamlined the patchwork of programs that currently measure value and quality into a single framework … where every physician and clinician has the opportunity to be paid more for providing better care for their patients,” Slavitt said.
He said CMS’ goal is to make the payment pathways under MACRA “flexible, transparent and simple so physicians can focus on patient care, not reporting or scorekeeping. Physicians know best how to provide high-quality care to our beneficiaries.”
Slavitt said three principles are guiding the agency’s implementation of the new Medicare payment systems:
- Keeping the focus on patient care. “Patients are—and must remain—the key focus,” Slavitt said. “Financial incentives should work in the background to support physician and clinician efforts to provide the highest quality care and create incentives for more coordinated care.”
- Allowing flexibility. The agency is working to ensure that physicians can adopt approaches that work for their practices, rather than forcing a “one-size-fits-all from Washington,” Slavitt said. “It will be important to allow physicians to define the measures of care most fitting with their patients.”
- Aiming for simplicity. “Physician practices are already busy, and we are seeking every opportunity possible to minimize distractions from patient care by reducing, automating and streamlining existing programs,” Slavitt said. “One of the reasons why we don’t have the hearts and minds of physicians is because there’s just too much paperwork in health care.”
Slavitt said the agency’s guiding principles were developed based on extensive feedback they received from thousands of physicians. He emphasized that physician feedback as the new Medicare payment systems are rolled out will be essential to their success.
“It is critical that we receive direct feedback from physicians and others stakeholders and are undertaking significant outreach efforts,” he said. “In the month of May alone, we have 35 scheduled events and listening sessions to hear from a wide range of stakeholders. It will take work and broad participation to get it right.”
Slavitt said the agency is looking for feedback from physicians—especially those in smaller practices—on how “what we do here in Washington” will impact their practices. He said they want to know what will work and what could have unintended negative consequences.
“We really do want to get to the best answer,” he said. “And we don’t have a monopoly on that.”
CMS is hosting a number of listening sessions, webinars and other opportunities for individual physicians to provide their insights.
A built-in physician feedback mechanism is the Physician-Focused Payment Model Technical Advisory Committee, which is collecting physician ideas for alternative payment models that can be tested for the new Medicare payment system.
The AMA and other medical associations also are providing feedback to CMS and will be submitting formal comment letters by the June 27 deadline.
The AMA offers a number of resources to help physicians in their initial preparations for the coming payment policies, including:
- A guide to physician-focused payment models
- Key points of the Merit-based Incentive Payment System
- What you can do now to prepare
- The AMA’s STEPS Forward™ collection of practice improvement strategies, which include advancing team-based care, implementing electronic health records, improving care and practicing value-based care