AAFP Shares Views on State of MACRA and Makes Policy Recommendations
The American Academy of Family Physicians (AAFP) has responded to a request for information from Congress on a potential solution to address financial uncertainties in the healthcare system associated with Medicare that have been getting progressively worse for years and were exacerbated by the COVID-19 pandemic. In 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law and replaced the sustainable growth rate (SGR) formula with the Quality Payment Program (QPP). MACRA changed Medicare’s approach to physician payment to paying providers based on quality, value, and the results of care delivered, instead of the old system that was based on the number of services provided.
While the United States invests more in healthcare than many other Western countries, the United States faces poorer healthcare outcomes and has a critical shortage of healthcare providers. One of the problems that has contributed to this is the Medicare Payment System, which has failed to maintain levels of provider reimbursement that adequately incentivize high-quality care. Congress has accepted that logistical challenges have plagued MACRA since its inception and has accepted that Congress may need to consider systemic reforms to healthcare financing.
Congress requested comment on the current state of MACRA and its effectiveness and wanted feedback for stakeholders on the regulatory, statutory, and implementation barriers that need to be addressed to allow MACRA to succeed and increase value in the U.S. health care system. Congress also sought suggestions on how MIPS and APM programs can be improved, and how to increase provider participation in value-based payment models.
The AAFP represents more than 127,600 family physicians and medical students in the United States. In its response, the AAFP explained that MACRA has left the majority of Part B clinicians in a state of financial insecurity as QPP does not adequately pay for Medicare physician services. While the authors of MACRA intended for physicians to receive an annual increase in the Medicare conversion factor (CF) for five years (2015–2019) followed by no change in the CF until 2026, that was not the reality. Between 2015 and 2019 the CF decreased twice and all the increases were less than the 0.5% prescribed by MACRA. The situation would also have been far worse if not for legislative interventions providing a temporary increase to the CF in 2021 and 2022.
“Without legislative intervention, budget neutrality adjustments will continue to erode clinician payment. The AAFP urges Congress to pass the Supporting Medicare Providers Act of 2022 (H.R. 8800) to avert a 4.42% reduction to the CF in 2023, which threatens practices’ ability to remain financially viable and continue serving Medicare beneficiaries,” explained the AAFP.
The AAFP also explained that in addition to budget neutrality limitations, Medicare physician payments have failed to keep pace with inflation. When adjusted for inflation, Medicare physician payments have reduced by 20% over the past 20 years. Physicians are having to cover increasing costs for staff, supplies, equipment, and leasing space and are having to make investments to help them transition into new payment models, but Medicare payments have effectively reduced. “AAFP and hundreds of other medical groups urge Congress to end the statutory freeze on annual updates to the fee schedule and enact a positive annual update to the CF based on MEI,” suggested the AAFP.
The AAFP explained that MACRA has not provided physicians with sufficient support to help them transition into alternative payment models that prioritize quality and value over quantity, has not achieved its original goal to streamline Medicare’s existing quality programs and simplify reporting requirements, is pushing practices to drastically accelerate from FFS to advanced APMs without regard to appropriate risk level, is not appropriately recognizing the adoption of other payer APMs, and MACRA’s overly prescriptive and complex approach to implementation has created unnecessary burdens for participants.
The AAFP offers several suggestions on how to improve the MIPS and APM programs including:
- Increasing the availability of APMs that rely heavily on prospective payments to meet the unique needs and flexibilities required for the sustainable delivery of physician-led, team-based comprehensive primary care.
- Providing technical assistance, shared learning collaboratives, and data infrastructure to support all primary care practices to transition to APMs
- Funding ongoing technical assistance programs to support the overall adoption of APMs by all practices in all settings
