Physician groups voice frustrations with Quality Payment Program

While doctors are generally supportive of payment reform goals under the Medicare Access and CHIP Reauthorization Act, they are concerned that MACRA’s quality measures—designed to reward value—are missing the mark.

That’s the consensus of physician groups that testified on Wednesday before a Senate committee hearing on the implementation of MACRA by the Centers for Medicare and Medicaid Services.

The American College of Surgeons “supports MACRA’s focus on quality and value,” said Frank Opelka, MD, medical director for quality and health policy at ACS. However, he told the committee that “a hurried CMS implementation has resulted in quality metrics that left surgical care as an afterthought.”

Opelka charged that CMS has relied on “their skills as a payer to retrofit a tired fee-for-service payment model with sporadic measures, which do not make sense to the surgical care teams and outcomes patients seek.”

MACRA offers clinicians two Quality Payment Program tracks to choose from: the Merit-Based Incentive Payment System (MIPS) or the Advanced Alternate Payment Models (APMs).

Opelka contended that, for many physicians, MIPS “has not and—given its current trajectory—will not serve as a driver of improvement in quality or reduction of cost.”

Likewise, John Cullen, MD, president of the American Academy of Family Physicians, testified that MIPS “has created a burdensome and extremely complex program that has increased practice costs and is contributing to physician burnout.” Further, Cullen observed that “understanding the requirements and scoring for each MIPS performance category and reporting data to CMS is a complex task and detracts from physicians’ ability to focus on patients.”

Barbara McAneny, MD, president of the American Medical Association, told the committee that the Quality Payment Program “still needs significant improvements,” and AMA’s physician members contend that “there is no link between many of the MIPS measures they are required to report and improving clinical care for their patients.”

McAneny said that the AMA urges Congress to continue to make technical changes to MACRA to simplify the QPP to make it “more clinically significant” because the measures that doctors are “required to report are taking time away from patient care.”

When it comes to healthcare IT, AMA has called for updating the Promoting Interoperability performance category to enable physicians to use certified electronic health record technology in “more clinically relevant ways.”

AAFP’s Cullen said in his testimony that one of the more concerning parts of MIPS is the Promoting Interoperability (PI) category, which is intended to promote patient engagement and electronic exchange of information using certified EHRs.

“CMS is hamstrung in PI since the agency is bound to Meaningful Use requirements by legislation, including both the American Recovery and Reinvestment Act and the Affordable Care Act,” Cullen says. “The AAFP calls on Congress to repeal Meaningful Use requirements and allow HHS to remove these requirements from the PI category.”

Also See: Physician groups call for tech changes to MIPS

While Cullen said AAFP is pleased that HHS is pursuing interoperability and stopping information blocking, the group remains “extremely concerned and adamantly opposed” to the “all or nothing” approach of the PI category.

“CMS should eliminate health IT utilization measures and remove any required measures, and provide eligible clinicians the flexibility to select measures relevant to their practice,” added Cullen. “Congress should encourage CMS to simplify the scoring, remove health IT utilization measures and the ‘all or nothing’ requirement, and hold health IT vendors accountable for interoperability before measuring physicians on EHR use.”

While Cullen noted that the AAFP supports the 2015 Edition Certified EHR Technology, he noted that the group has concerns with it being mandated for eligible clinicians. “We strongly encourage CMS to not mandate 2015 Edition CEHRT, but rather incentivize its adoption through scoring, which benefits 2015 Edition CEHRT users.”

Opelka from the American College of Surgeons complained about the Qualified Clinical Data Registries for MIPS, which are meant to advance improvements in quality and patient outcomes by providing actionable feedback to participating providers related to their performance on key metrics.

“We do firmly believe in registries—we run seven international registries to date—but putting them into the MACRA payment programs is not actually taking full advantage of how you would leverage data for better care,” said Opelka, who made the case that only when registries have standardized data, aggregation, normalization and reporting from a “single source of truth” are they valuable.

“What we need is government guidance about how we actually set standards in key areas, how we define the data that enters registries, how that data is aggregated in a consistent manner so it comes in cleanly, how we can normalize and analyze that data together, and how we can represent it back out to patients and physicians as it’s needed,” Opelka added. “Right now, it’s the Wild West.”