The Society Joins AMA and Others in Urging Congress to Ensure Flexibility with QPP

This week, the Society along with the American Medical Association and more than 100 national and state medical societies sent a letter to the House Committee on Energy and Commerce, ranking members of the House Ways and Means and Senate Finance committees, urging them to enact legislation to ensure that the Center for Medicare & Medicaid Services (CMS) has the flexibility to continue a transitional approach to the implementation of the Quality Payment Program (QPP) under MACRA.

The letter urges lawmakers to continue existing flexibility in the Medicare Access and CHIP Reauthorization Act (MACRA) statute that CMS is currently using for an additional three years, so that the agency may move forward as the necessary program elements are put into place. Some of those flexibilities include statues that have allowed CMS to proceed with implementation of MACRA despite that fact that resource use (cost) measures necessary under Merit-based Incentive Payment System (MIPs) are still under development. This allows the Secretary, for the first two years of MIPs, to weight the resources use component at not more than 10 percent for the first year and not more than 15 percent for the second year. CMS has used this flexibility in the 2017 and 2018 rules to weigh resource use at zero percent which is “an acknowledgement that work remains to be done to ensure that these new measures are developed and integrated in a way that accurately reflects the complexities of cost measurement and does not inadvertently discourage clinicians from caring for high-risk and medically complex patients, as was the case under the value-based modifier,” the letter states.

Another flexibility MACRA provided allows the Secretary to select a performance threshold during the first two years other than the “mean or median” standard. “Gradually increasing the performance threshold gives physicians the opportunity to implement necessary practice changes as they gain experience. It also ensures that the performance threshold is not set too high, which could discourage participation or negatively impact practices with fewer resources.”

Both of these provisions expire after the second year of MIPs and CMS will be required to implement a “mean or median” performance threshold and count resources use measures for a full 30 percent regardless of readiness or applicability as early as their Spring 2018 proposed rule.