CMS acting Administrator Andy Slavitt struck a strongly conciliatory tone Wednesday at the second meeting of the committee created to evaluate payment models to be used in Medicare's new reimbursement for physicians.
Physician input is critical for the success of the Medicare Access and CHIP Reauthorization Act and the CMS wants providers on the front lines to tell them how models can best work in practice, Slavitt said.
“It's the work we do implementing it that matters,” he said. “I think we all know that and you have to help us get out of our box and closer to where care is provided.”
MACRA created the 11-member committee to advise the HHS secretary on physician-focused payment models. Providers will submit models to the committee and some will be tested. It had its first meeting in January.
Proposed rules released last week give some details on MACRA, which gives providers two options for transitioning to value-based payment. They can participate in the Merit-based Incentive Payment System or use a qualifying alternative payment model.
Tim Gronniger, deputy chief of staff at the CMS, said the agency understands the criteria for advanced APMs is strict. Staff are looking for ways to reward those who try regular APMs and those who attempt difficult models but cannot fully complete them. The CMS also wants to make it relatively easy for practices to switch between tracks.
Slavitt said the CMS also knows the new guidelines will be a particular challenge for small and rural practices with less infrastructure and cash on hand. The agency plans to reduce reporting requirements for small practices.
Gronniger said models will be judged on how they promote value over volume, protect patient safety, encourage patient engagement and use health information technology. Models should also be able to be evaluated and be adaptable. Other helpful information would include the size and scope of the model and information about the patient population it will serve.
Len Nichols, committee member and director of the Center for Health Policy Testing and Ethics at George Mason University, said physicians are wary of the reformed model, although they are glad to see the end of the sustainable growth rate, which created uncertainty because payment rates were determined by annual legislative actions.
“I'm here because I'm really worried about physician morale,” he said. “I've traveled across the country and talked to doctors. At the same time, there's a tremendous energy to improve.”
Committee Chairman Jeff Bailet, president of the Aurora Health Care Medical Group, part of a 14-hospital system based in Milwaukee, said the committee wants to encourage creative thinking and provide enough feedback so that proposals can be made successful.
“We do not want to be seen as goalies or as gatekeepers or as people to suppress innovation,” he said. “It's exactly the opposite.”