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MACRA's future seems solid—for now—under the Trump Administration

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No matter what happens with the healthcare system in the United States under the Trump administration, the Medicare Access and CHIP Reauthorization Act (MACRA) almost certainly will survive in some form.

Health IT advocates are watching the healthcare happenings with the administration and are positioning themselves to help maintain a smooth transition.

“Health IT is critical to the kind of shift from volume to value-based care, and the Quality Payment Program (a component of MACRA) is one part of supporting that shift to more value-based care,” said Jeff Coughlin, senior director of federal and state affairs for the Health Information and Management Systems Society (HIMSS). “We’re working with the new administration to emphasize the important role health IT can take in the shift.”

The administration’s budget priorities also are under scrutiny and a potential source of concern. The “America First” budget blueprint issued by the White House Office of Management and Budget in mid-March asked Congress for a 17.9 percent decrease in the 2017 funding level for Health and Human Services, including an 18.3 percent decrease in funding for the National Institutes of Health.

The final version of the budget is expected to be released in May, at which point health IT stakeholders will have a better idea about the potential long-term ramifications for research and quality healthcare delivery.

Budget questions aside, the evidence so far falls squarely in MACRA’s favor, based in part on statements and the voting record of former Rep. Tom Price, R-Ga., now the Secretary of Health and Human Services.

To begin with, MACRA received solid bipartisan support in the House of Representatives, where it passed 392-37. Price voted in favor of the bill, and the Centers for Medicare and Medicaid Services (CMS) has begun its implementation of the Quality Payment Program, which replaced the Sustainable Growth Rate formula used to calculate reimbursements pre-MACRA.

Regardless of whether the Affordable Care Act (the ACA, also known as Obamacare) is repealed, MACRA is likely to remain intact at least through 2017. Neither MACRA nor the related Merit-based Incentive Payment System (MIPS) appear to be under discussion as the Republican-led Congress debates how best to keep its promise to repeal and replace the ACA.

If a repeal bill reaches Trump’s desk, chances are the new system of Medicare reimbursement will remain in place.

Indeed, Price went so far as to praise MACRA as a fine example of political bipartisanship, and gave the new system of Medicare reimbursement a tacit endorsement during his confirmation hearings with the Senate.

However, he seemed to hedge on full-throated support for MACRA by emphasizing the importance of what he considers proper implementation.

“I think significant challenges remain with respect to provider burden,” Price responded to a confirmation hearing question about the implementation of MACRA. “If confirmed, I plan to direct the CMS Administrator to ensure that the program is structured to achieve its quality and budgetary goals, while ensuring that patients and the providers who care for them are at the center of our reform efforts.”

Price went on to explain his vision for proper MACRA implementation. “I commit to work closely with the CMS Administrator,” he said during his hearings, “to make sure we implement MACRA in a way that is easy to understand, minimizes burden, and is fair to all affected providers.”

For further insight into Price’s thinking regarding MACRA, it is instructive to consider his responses to this line of questioning from his confirmation hearing:

Question: Do you agree that the traditional fee-for-service payment system – in which providers are paid based on volume instead of value – creates incentives for overutilization of health care services?

Price: Our healthcare system is complex, and we cannot attribute overutilization trends to a single cause. For instance, efforts to curb overutilization in emergency rooms have been unsuccessful. Overutilization is a complex issue that needs to be carefully addressed.

Question: Do you also agree that the successful implementation of the bipartisan Medicare Access and CHIP Reauthorization Act (MACRA) will require the continued development of value-based payment models?

Price: The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is built on the principle of encouraging providers to develop Alternative Payment Models (APMs) that can ultimately be adopted by CMS and commercial payers.

Question: Will you commit to supporting the continued development of value-based payment models in Medicare and increasing the percentage of provider payments made through those models?

Price: We share the goal of improving Medicare by empowering providers to be creative and develop payment models that best suit the unique needs of their patients to ultimately improve patient care.

All of which is to say that Price, while not willing to fully endorse the final MACRA rule as defined by CMS in October, seems to be aware that the ongoing debate about the ACA and its potential replacement plan—whether that is the contentious American Health Care Act or something else—is going to demand a lot of his attention in 2017, leaving little if any time to pursue major changes to Medicare reimbursement procedures.

MACRA’s Final Rule has appeal for an administration that promises a more limited approach to the federal government’s role in healthcare. For instance: Whereas the beleaguered Stage Three of Meaningful Use had 18 required interoperability measures to report on for Medicare doctors, MACRA only has five.

Some key health IT provisions in MACRA to be aware of, according to a report by Healthcare Informatics’ Rajiv Leventhal are:

  • Incentivizing use of qualified EHR
  • Data blocking surveillance
  • Streamlined health IT requirements for physician’s practices
  • Growing need for keeping EHR technology up-to-date

Meanwhile, healthcare providers, insurance providers and citizens continue to monitor the efforts by Congress and the Trump administration to reconcile their promise to repeal and replace with ongoing efforts to control costs while improving the efficiency and quality of healthcare in the U.S.

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