| Today's Managing Health Care Cost Number is 92 |
MACRA, the Medicare Access and CHIP Reauthorization Act, passed Congress in 2015 with huge bipartisan majorities (397-37 in the House and 92-8 in the Senate), and many feel that this means that payment reform in the US has unstoppable momentum.
MACRA was passed when it seemed likely the next President would want to continue the Obama legacy in health care, and when there was finally a Congressional Budget Office cost estimate that made it feasible to repeal the Sustainable Growth Rate regulations, which had threatened massive cuts in professional Medicare payments each year. Republicans like Tom Price, now the HHS Secretary, voted "aye" to take giant Medicare physician fee cuts off the table. But their commitment to payment reform was never clear.
MACRA includes substantial future fee cuts to physicians who don’t adopt electronic medical records and meet certain quality goals, and allows physicians who are part of alternative payment methods like accountable care organizations to escape from these rules. The provider community has made a huge investment in migrating into "risk" arrangements for Medicare and non-Medicare patients, and to build the infrastructure to be able to manage the health of populations, as opposed to just issuing fee for service bills.
An article in StatNews yesterday shows that Tom Price is working feverishly to undermine MACRA - and free physicians to continue to practice in the old "fee for service" way for the foreseeable future.
Doctors — many of whom have been vocally opposed to the efforts to repeal Obamacare — are over the moon about the steady drumbeat of regulatory rollbacks… “We’re not used to having wins, and all of a sudden we’re getting these rules where a lot of what we asked to have happen is happening,” said one physician industry official, speaking on condition of anonymity to speak candidly.
Tom Price and the Center for Medicare and Medicaid Services have retrospectively diminished the "stick" pushing physicians toward using EMRs or putting in safety processes ; physicians who failed to meet 2016 requirements will not be penalized as scheduled in 2018. He has also exempted more physicians from MACRA requirements.
CMS has also delayed expansion of the Comprehensive Care for Joint Replacement, and has expressed opposition to the Obama Administration's preferred approach of implementing this program in randomly chosen communities - which would have made facilitated rigorous studies of its impact. CMS is also delaying the Cardiac Rehabilitation Incentive Payment Model -and the Trump Administration has pushed for defunding of the Centers for Medicare and Medicaid Innovation, which has coordinated many payment reform initiatives.
Many still believe payment reform is inevitable. But changing payment methodologies is hard- and most likely to succeed if Medicare leads the way. 92 senators is not a big enough majority to drive payment reform with an administration not fully committed to the effort.
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