Doctors face barriers in move to value-based care under MACRA, congressional committee told

Physicians continue to face barriers and need support as they move to new payment models under MACRA, physician leaders told a congressional committee this morning.

The House Energy and Commerce Health Subcommittee held the hearing to receive an update on advanced alternative payment models (APM), one of the two payment tracks under the Medicare Access and CHIP Reauthorization Act (MACRA).

“Providers who are ready and willing to lead change continue to face obstacles to transforming care and payment and need additional support,” said Elizabeth Mitchell, vice chairperson of the Physician-Focused Payment Technical Advisory Committee (PTAC), the group set up under MACRA to evaluate new payment models submitted by physician groups.

In its first year of evaluating payment proposals, the PTAC has identified three common barriers that Congress must address to fully achieve the potential of MACRA and move ahead with implementation of physician-focused payment models and APMs, Mitchell said. Those include the need for:

Greater technical assistance. While physicians have experience changing care delivery, most have not been trained in the development of incentives, payment models or risk management, she said. In particular, the lack of resources and expertise to develop and implement new models threatens to leave small and rural practices out of the transition to value-based care.

Greater access to shared data. Doctors need better and more timely access to clinical and claims data to identify areas of improvement and then track quality and resource use to ensure that care innovation occurs, she said.

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Limited-scale testing of innovative models. Like any innovation, promising new payment models require testing in the field to fully understand implementation barriers and unintended consequences before being rolled out nationally, she said.

Despite the barriers, Mitchell and Jeffrey Bailet, M.D., chairman of the PTAC, said they have seen no slowdown in proposed new payment models. Since the MACRA final rule was released a year ago, PTAC has deliberated on six proposals and voted on five, sending three models to the HHS Secretary for approval for small-scale testing or implementation, Bailet said. The committee has 14 new proposals under active review, he said.

The congressional subcommittee is committed to making MACRA and the movement to APMs a success, said U.S. Rep. Michael C. Burgess, M.D., of Texas, who chairs the health subcommittee. APMs are not the easiest path for physicians to take in the move to value-based care, but it is the best one, he said.

As well as hearing from PTAC leaders, the subcommittee also heard from physicians who have set up APMs. “While there has been concern that alternative payment models are not delivering real savings for the nation, it is clear that with a planned approach and effective execution, these models can and are working,” said Daniel Varga, M.D., chief clinical officer and senior executive vice president for Texas Health Resources, who reported on the results his organization has achieved. 

Last week, the Centers for Medicare & Medicaid Services released a final rule on the Quality Payment Program that the agency said is meant to ease burdensome regulations. Among the provisions is a change to make it easier for practices to participate in advanced APMs, which may allow them to quality for greater incentive payments.