Congress Asks, TMA Delivers: 50 More Ways to Fix Medicare

In mid-February, Texas Medical Association leaders gathered in a Capitol Hill office building with a pair of the most powerful members of Congress on health care policy. Both are Texans: U.S. Reps. Kevin Brady (R-The Woodlands), chair of the House Ways and Means Committee; and Michael Burgess, MD (R-Lewisville), chair of the House Health Subcommittee.

Both men brought their top staff along for a discussion about physicians’ problems with Medicare and with the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, a law that has generated tremendous amounts of confusion and anxiety among physicians. How, they asked, should it be fixed?

Cardenas_MAcra“It’s so important to Texas physicians that these two congressional leaders really want to know how this law is and isn’t working from our point of view,” said TMA President Carlos J. Cardenas, MD. “They looked us in the eye and said, ‘Tell it like it is.’ So we did.”

The outcome of that conversation, a 21-page, meticulously footnoted document, was delivered this week to Chairman Brady, Dr. Burgess, and their aides. 

“Improving and Simplifying the Medicare Quality Payment Program” lists 50 recommendations to increase physicians’ Medicare pay; reduce paperwork and hassles; measure “quality” with metrics that are meaningful to physicians and their patients; and push health information technology (HIT) vendors to shoulder their fair share of the administrative burden.

Adjusting physicians’ Medicare fees with medical inflation — like the payments made to hospitals, nursing homes, and others — is the most badly needed reform. Such a plan would replace decades of price fixing. 

“The long-term historical strategies to limit physician fees have been based on the flawed premise that cutting payments to physicians would be an effective method to limit overall Medicare spending growth,” the report notes.

Among the “constellation of effects” of inadequate physician fees: closures of small physician practices, increases in hospital employment of physicians, and physicians intentionally limiting their acceptance of Medicare patients.

TMA submitted a 12-point bulleted list of reasons why MACRA’s costly, overly complex, and burdensome Quality Payment Program (QPP) does little to incentivize high-quality, low-cost care.

“Performance on [QPP] measures often is impacted by social determinants of health, which are not in a physician’s control,” TMA stressed. “The current … program does not use adequate coding or risk adjustment to neutralize these impacts.”

The paper also analyzes the pros and cons of two recent proposals to eliminate a key piece of the QPP: MedPAC’s voluntary value program suggestion, and the Trump administration’s plan to evaluate physician performance based on quality and cost metrics at the group level only, with all data obtained from administrative claims and patient experience surveys.

The other major proposals in TMA’s “Recommendations to Support Physicians in Their Move to Value-Based Care and Alternative Payment Models”: 

  • Improve and simplify the QPP and make participation voluntary;
  • Abandon burdensome requirements for electronic health records;
  • Eliminate payment penalties and budget neutrality;
  • Enhance interoperability of health information technology;
  • Use quality and cost metrics that capture only what is under physician control;
  • Remove requirement for downside risk to earn incentives in the Alternative Payment Models track; and
  • Provide more education and technical assistance to support physicians in their move to value-based care and alternative payment models. 

All told, the policy paper includes 50 specific recommendations for Congress or the Centers for Medicare & Medicaid Services (CMS) to consider.


Coincidentally, that is the same number of changes TMA submitted to CMS in June 2016 in response to the agency’s first set of MACRA rules. “The system devised by CMS is far more costly, complex, and confusing than the costly, complex, and confusing programs it is replacing,” then-TMA President Don R. Read, MD, said at the time.

TMA followed that up with 51 recommendations on CMS’ proposed MACRA rule revisions in August 2017.


Last Updated On

May 02, 2023

Originally Published On

April 18, 2018

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