Physicians participating in the Quality Payment Program’s Merit-Based Incentive Payment System (MIPS) and alternative payment models (APMs) need help from Congress to succeed, and lawmakers need to undo an upcoming freeze on Medicare payments.
That’s what the American Medical Association (AMA), the Texas Medical Association, and dozens of other medical societies told House of Representatives and Senate leaders in both parties in a letter sent last week. The letter addressed improvements medicine would like to see with the Medicare Access and CHIP Reauthorization Act (MACRA), specifically with MIPS and APMs.
The organizations urge Congress to revisit the upcoming six-year freeze on physician payments in Medicare. That six-year freeze begins next year and ends following 2025. At that point, there’s a scheduled payment increase of just 0.75% for physicians participating in APMs, and 0.25% for physicians participating in MIPS.
“By contrast, other Medicare providers will continue to receive regular, more stable updates,” the letter said. “As physician practice payments fall increasingly below their costs, patient access issues would arise.”
Noting that the Centers for Medicare & Medicaid Services (CMS) has said physician fee schedule payments cover only about 60% of typical direct costs, the letter asks Congress to replace the six-year pay freeze with “a stable and sustainable revenue source that allows [physicians] to sustain their practice” and invest in improvements.
Medicine’s letter also asks Congress to extend the Advanced APM incentive payments for six more years. MACRA instituted an incentive payment of 5% for physicians in the first six years of the program, an incentive for physicians to move into innovative payment models. But as the letter notes, only limited Advanced APM opportunities have existed for physicians in the first three years of the program during 2017-19, and only three more years of the incentive payments remain.
MACRA also needs a slew of technical improvements to simplify MIPS and make quality reporting more clinically meaningful, medicine told Congressional leaders. Those include allowing physicians to focus on specific conditions, public health priorities, or episodes of care, instead of “segregated measures divided into four disparate MIPS categories”; and allowing CMS to develop multiple performance thresholds, such as separate thresholds for small and rural practices.
The letter, sent Monday, is addressed to U.S. Rep. Nancy Pelosi (D-Calif.), House speaker; Rep. Kevin McCarthy (R-Calif.), House minority leader; Sen. Mitch McConnell (R-Ky.), Senate majority leader; and Sen. Charles Schumer (D-N.Y.), Senate minority leader. TMA also recently submitted a resolution to the AMA suggesting further QPP improvements.
If you need QPP help in your practice, visit TMA’s MACRA Resource Center.