MACRA shouldn't hurt small physician practices, members of Congress say

Physician burnout

Members of a congressional committee had a clear message Wednesday: fix a proposed rule on a new Medicare physician payment system so it does not hurt small physician practices.

Andrew Slavitt, acting administrator for the Centers for Medicare & Medicaid Services, said his agency welcomes and is listening to feedback from physicians on a proposed rule to implement the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and wants the payment system to be fair to all physicians.

"If CMS is trying to win back the hearts and minds of physicians, this proposal falls short," U.S. Rep. Sam Johnson, (R-Texas), told Slavitt at a hearing before the House Ways and Means Committee to discuss the MACRA rule.

In comment after comment, members of the committee said they did not want MACRA, which will determine physician reimbursements under Medicare, to hurt solo doctors and those in small practices. CMS released the proposed rule in late April and Slavitt said he has already talked to thousands of physicians across the country. CMS' own data suggests 87 percent of solo practices will see negative adjustments in payments amounting to $300 million under the proposed rule. But Slavitt said those numbers are based on 2014 data, when most small and solo practices were not reporting quality data, and will be updated in the final rule. "I don't believe it is reality," he said.

"It will take work and broad participation to get it right," he said, of a final rule on implementation. He said it is of upmost importance that physicians in small and rural practices have the opportunity to do just as well as physicians in larger practices under the new payment system.

Asked what message he would give to physicians concerned about MACRA implementation, Slavitt made five points:

  • Keep focusing on patients and patient care. "Don't worry about score keeping," he said, as it is CMS' job to streamline the patchwork of existing programs under MACRA.
  • Ultimately physicians will decide quality measures and select goals that are right for their practices, he said.
  • In the meantime, physicians should take opportunities to participate in alternative payment models.
  • Physicians won't have to report on MACRA until spring 2018.
  • Doctors should continue to provide feedback to CMS. "We need physicians who are practicing every day to give us feedback on what works about the rule and what might have unintended consequences," he said.

To learn more:
- listen to the committee hearing