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Physician anesthesiologists and their practices are beginning to think about 2018 and the rules and regulations that may affect their future Medicare payments. In the upcoming days and weeks, ASA expects that the separate final rules of the Medicare Physician Fee Schedule (MPFS) and the Quality Payment Program (QPP) of the Medicare Access and CHIP Reauthorization Act (MACRA) will be released. Once those rules are released, ASA will develop materials for your practice to understand what has changed and what has stayed the same for next year.
In recent weeks, trade magazines and online blogs have flashed headlines reporting that the Medicare Payment Advisory Commission (MedPAC) called for an end to the Merit-based Payment Incentive Program (MIPS) or, at the very least, “urged” repeal of MIPS. As many readers know, MIPS is one of two pathways under the MACRA QPP – the other pathway being Advanced Alternative Payment Models or APMs. MIPS requires physician anesthesiologists and practices who bill Medicare to submit data on quality measures and advancing care information as well as attesting to several improvement activities.
Although MIPS has come to represent a burden on many practices, neither the U.S. Congress nor the Centers for Medicare & Medicaid Services (CMS) have signaled any intention to repeal the MACRA law or halt its implementation. MACRA legislation (which includes the establishment of the QPP with both the MIPS and APM pathways) enjoyed strong bi-partisan and bi-cameral support when Congress passed it in 2015. Moreover, MACRA repeal would create a payment policy vacuum as the previous payment mechanism – the Sustainable Growth Rate (SGR) formula – was repealed with the passage of MACRA. It is possible that there will be legislative action to address some of the known concerns with MACRA but that action will not be the same as full-out repeal. The MACRA discussions are separate from the debate involving the Affordable Care Act.
Physician anesthesiologists curious about MedPAC and its influence upon the U.S. Congress should understand MedPAC’s role in making health policy. MedPAC was established by the Balanced Budget Act of 1997 and, as an independent congressional agency, its 17 commissioners advise the U.S. Congress “on payments to private health plans participating in Medicare and providers in Medicare's traditional fee-for-service program.” The body also analyzes “access to care, quality of care, and other issues affecting Medicare.” MedPAC does not have the power or authority to amend existing law. However, the commission can make recommendations to Congress and respond to inquiries from the US Congress. The commission can also discuss healthcare policies for federal agencies and healthcare stakeholders to consider. MedPAC discussion are open to the public and their transcripts are available online.
At its October 5 meeting, MedPAC discussed the future of MIPS and its commissioners noted the shortcomings of the law – that quality measures do not always differentiate care, that MIPS will not necessarily expedite the movement from fee-for-service to value-based payments and, like many physician anesthesiologists already know, that MIPS creates significant burdens on practices. But MedPAC’s transcripts also show that the discussion focused more on primary care than on specialty care. Several commissioners noted this problem and requested that future policy discussions consider the potential winners and losers of changing any elements of MIPS in the future.
ASA expects that final rule for the CY2018 MPFS and the 2018 QPP will be released in late October. These rules will ground physician anesthesiologists and their practices on short- and long-term objectives of the Centers for Medicare & Medicaid Services.
For more information, contact ASA at [email protected] or (202) 289-2222.
