AMA, AHA Respond to Final MACRA Rule

The American Medical Association (AMA) today released the following statement in response to the Centers for Medicare and Medicaid Services' (CMS) final rule on Medicare payment and delivery reform, as created by the Medicare Access and CHIP Reauthorization Act (MACRA):

"The AMA acknowledges the commitment by Acting Administrator Andrew Slavitt and his senior team at CMS for listening to physician concerns and taking several concrete steps to help them adjust to this new Medicare payment framework," said AMA President Andrew W. Gurman, MD. "By announcing the 'Pick Your Pace' approach to give physicians greater flexibility and increased options for participating in MACRA in 2017, HHS Secretary Burwell and Acting Administrator Slavitt took a significant step last month to address AMA concerns about the original proposal. The final rule includes additional steps to help small and rural practices by raising the low volume threshold exemption, and practices of all sizes will benefit from reduced MIPS reporting requirements.

"Our initial review indicates that CMS has been responsive to many of the concerns raised by the AMA, and in the days ahead, the AMA will conduct a comprehensive review of the final rule to ensure that it promotes flexibility and innovation in the delivery of care to help meet the unique needs of all patients. With the flawed Sustainable Growth Rate (SGR) formula - and its annual threat of steep payment cuts - permanently eliminated, the new law gives many physicians the opportunity to be rewarded for the improvements they make to their practices and for delivering high-quality, high-value care to Medicare patients."

To help prepare physicians for the new regulations, the AMA this month unveiled practical tools to help them succeed under the new program, which will go into effect in 2017.

The new resources are:

The AMA Payment Model Evaluator, an innovative tool offering initial assessments to physicians so they can determine how their practices will be affected. Developed with the expertise of physicians, the tool will give physicians and their staff a brief assessment, as well as relevant educational and actionable resources. Once physicians and medical practice administrators fill out the online questionnaire, they will receive guidance for participating in the MACRA payment model that is best for them. The AMA will continually update the Payment Model Evaluator to respond to regulatory changes and to keep practices up to date throughout the new payment and care delivery reform process. The tool is free to all physicians and their practice administrators.

The AMA STEPS Forward™ collection of practice improvement strategies has new MACRA-specific tools. Accurate and successful reporting on quality metrics is crucial to the new Medicare payment system, both in the current Physician Quality Reporting System program and under MACRA's new Quality Payment Program. Each STEPS Forward module focuses on a specific challenge and offers real-world solutions, steps for implementation, case studies, continuing medical education, and downloadable tools and resources. Physicians and their practice staff can use these to help improve practice efficiency and ultimately enhance patient care, physician satisfaction and practice sustainability.

The AMA launched a ReachMD podcast series titled Inside Medicare's New Payment System. Notable healthcare experts are featured on the series, which will include five episodes to help physicians be informed on upcoming Medicare changes.

These new tools build on earlier, significant AMA efforts to ensure that physicians and their practices are prepared for MACRA: The MACRA webpage on the AMA's website has been a source of information on the changes facing physicians and their practices, and will continue to be a frequently updated source of information as the regulations are fine-tuned.

AHA Statement

Tom Nickels, executive vice president for Government Relations and Public Policy for the American Hospital Association, released the following statement on Friday afternoon:

Today's final Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) rule presents challenges and opportunities for hospitals and health systems, and the nearly 540,000 directly employed or contracted physicians with whom they partner to deliver quality care.

While we are disappointed that CMS continues to narrowly define advanced alternative payment models (APMs), which means that less than 10 percent of clinicians will be rewarded for their care transformation efforts, we are encouraged that CMS is exploring a new option that would expand the available advanced APMs that qualify for incentives. We urge CMS to ensure that this option be available in 2017 and look forward to working with them so this new model achieves an appropriate balance between risk and reward.

We are pleased that CMS has provided clinicians with increased flexibility to meet MACRA's aggressive timelines and reporting requirements. By allowing them to "pick their pace," clinicians in a variety of settings will be able to more easily transition to the new program. Furthermore, CMS's final measures for the advancing care information category of the Merit-based Incentive Payment System (MIPS) offer some welcome relief from the overly aggressive initial proposal.

At the same time, the AHA remains concerned that the lack of sociodemographic adjustment to the measures used in the MIPS will unfairly disadvantage clinicians and hospitals caring for the poorest patients. Opportunities also remain to further align hospital and clinician performance measurement, and we will work with the agency to make that happen.

We continue to review the details of the final rule and will provide guidance to hospitals and their clinician partners. As implementation moves forward, we remain committed to making sure patients benefit from the transformation of care envisioned by MACRA.