GOP Doctors Caucus: We’ll fix MACRA if CMS won’t

As they analyze the 2,398-page final rule revamping Medicare reimbursement, Republican physician lawmakers say they will, if needed, intervene to improve the regulations for the nation’s physicians.

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The 18-member GOP Doctors Caucus is reviewing the final rule released October 14 by the Centers for Medicare & Medicaid Services (CMS) governing how Medicare will reimburse doctors under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

“If the final rule is not satisfactory, the Doctors Caucus will look at a possible legislative fix. Our top priority is getting this right for patients and practitioners,” Rep. Phil Roe, MD, tells Medical Economics. A co-chair of the caucus, Roe represents Tennessee’s First District.

In response, CMS Acting Administrator Andy Slavitt told Medical Economics the agency worked closely with the Republican group and other physicians in crafting the final rule.

“I’ll leave legislating to Congress because that’s what they do,” Slavitt says. “If I was a physician, I wouldn’t sit back and think, ‘Maybe there will be legislation to change things,’ however.”

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Rep. John Fleming, MD, of Louisiana’s Fourth District, the caucus’s other co-chair, says MACRA and its reporting requirements are likely to frustrate doctors who would prefer to spend their time caring for patients rather than reporting on quality measures. If the final rule is too onerous for physicians to meet requirements, especially through the law’s Merit-based Incentive Payment System (MIPS) where most small practices will fall in 2017, Fleming is concerned many physicians may opt for direct-pay practice models and eliminate Medicare patients from their panels.

MACRA establishes what CMS calls its Quality Payment Program, which includes two ways for doctors to receive Medicare reimbursements: MIPS and Advanced Alternative Payment Models (APMs).

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A physician in an APM, like a Next Generation Accountable Care Organization or the Comprehensive Primary Care Plus program, bear financial risk tied directly to the APM’s performance.

For Roe and Fleming, both APMs and MIPS are too complex, the reporting performance periods are unrealistic and the measures built into MIPS may not assess physicians’ performance accurately, they say. They also feel that MACRA will force small and rural practices to combine with larger physician groups or sell out to hospitals.

“There’s a much better way to approach quality measures and attain quality than something where the government puts doctors through unnecessary exercises where they’re spending less time thinking about and listening to patients, and more time checking boxes and filling in blanks,” Fleming says.

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Instead of having CMS set quality measures, the government should let each medical society determine what constitutes quality through evidence-based research, Fleming adds.

The caucus explained its objections to MACRA in an October 6 letter to Slavitt and Shaun Donovan, director of the Office of Management and Budget, stating the Doctors Caucus’ concern. At press time, neither Slavitt nor Donovan had responded to the letter.

Both Roe and Fleming voted for MACRA because it replaced the onerous and universally unpopular sustainable growth rate formula. But when CMS wrote the proposed rules to implement MACRA, those writing the rules made the law more complex, Fleming says.

That complexity is likely to cause physicians to stop accepting Medicare patients, he told Medical Economics. “The bottom line is you have more and more doctors saying, ‘We can’t even figure out this rule,’” says Fleming, a primary care physician running for the U.S. Senate this year. “For my employees, it just seems like we have to do more and get paid less.”

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MIPS may force physicians to spend less time with patients, he says, because they would need to devote so much effort to monitoring and reporting their performance in order to achieve MIPS’ quality goals. Even small physician groups of 10 or fewer would need to expend limited resources to monitor their performance on more than 20 measures, he added.

The timeline for physicians to measure their performance is also unrealistic, the letter said. The caucus said in its letter it wanted to ensure that physicians have time to prepare to comply with MACRA. Under the final rule, physicians can begin measuring their performance January 1, although some may choose to defer their participation until later in the year under options CMS offered in the final rule.