New Directions for Medicare Physician Payment

In April, the U.S. Department of Health and Human Services (HHS) issued a proposed rule to implement the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA. Congress passed this bipartisan legislation last year to replace the sustainable growth rate formula (SGR)—which tied the growth of Medicare physician payments to growth in the economy—with an approach that rewards high-performing providers and supports alternative payment models.

Last month, nearly 200 congressional and administration staff, journalists, and other stakeholders convened in Washington, D.C., for a briefing hosted by the Alliance for Health Reform to discuss the MACRA legislation and its implementation. The briefing featured Elizabeth Mitchell, president and CEO of the Network for Regional Healthcare Improvement; Kate Goodrich, M.D., director of the Center for Clinical Standards and Quality at the Centers for Medicare and Medicaid Services (CMS); Timothy Ferris, M.D., senior vice president at Partners HealthCare; and Ashley Thompson, senior vice president at the American Hospital Association (AHA). Moderating the briefing were Sarah Dash of the Alliance for Health Reform and Rachel Nuzum, Commonwealth Fund vice president for federal and state health policy.

According to Mitchell, MACRA could be even more transformational than the Affordable Care Act (ACA) in aligning provider payment with value rather than volume. She underscored that bringing health providers up to speed quickly is essential as the payment changes that take place in 2019 will be based on provider performance in 2017. To support clinicians preparing for the payment changes under MACRA, CMS announced $10 million in additional funding under their Transforming Clinical Practice Initiative.