CMS Gives Physicians a Hand as Congress Prepares for Round 2 of Repeal-and-Replace

June 23rd, 2017

It was a big week for healthcare news, full of mixed emotions and worry over the future of healthcare reimbursement and whether the most vulnerable in society will still have access to the care they need.

The Centers for Medicare and Medicaid Services (CMS) released its proposed new draft rule of updates for the Quality Payment Program in calendar year 2018. CMS proposes to exempt even more physicians from alternative and merit-based payment programs of the Medicare Access and CHIP Reauthorization Act of 2015. The original rule exempted physician practices with less than $30,000 in Medicare reimbursement or fewer than 100 Medicare patients from MACRA technology and quality measures that many physicians found overly burdensome. The proposed 2018 rule exempts practices with less than $90,000 in Medicare reimbursement, or fewer than 200 Medicare patients — leaving only 37% of Medicare physicians operating under MACRA payment models. The rule also extends electronic health record (EHR) stage 2 meaningful use requirements through the end of 2018 — another provision that caused anxiety in smaller practices.

“We’ve heard the concerns that too many quality programs, technology requirements, and measures get between the doctor and the patient,” CMS Administrator Seema Verma said upon the rule’s release. “By proposing this rule, we aim to improve Medicare by helping doctors and clinicians concentrate on caring for their patients rather than filling out paperwork.”

The healthcare industry reaction has been cautiously optimistic. “We are encouraged by CMS’s proposal for a facility-based clinician reporting option that may promote better alignment and collaboration on efforts to improve quality among hospitals and clinicians,” said American Hospital Association (AHA) Executive Vice President Tom Nickels in a statement. “We also applaud CMS’s proposal to provide much-needed relief from unrealistic, unfunded mandates for EHR capabilities by extending the use of modified stage 2 meaningful use requirements through 2018.”

Yesterday, the Senate released its hotly anticipated Affordable Care Act (ACA) repeal-and-replace bill — which was met with about as much enthusiasm as the roundly maligned House version. The Better Care Reconciliation Act of 2017 offers little change to the House’s American Health Care Act and includes the following:

• ending the federal dollars for the Medicaid expansion and cap federal funds to the states;
• placing a one-year ban on Medicaid funding for Planned Parenthood;
• lowering income requirements for tax subsidies to 350% of the poverty line, down from 400%;
• eliminating the controversial individual mandate and its related tax penalty;
• giving states the option to drop essential health benefits from insurance plans;
• eliminating tax increases, including the so-called “Cadillac tax,” a measure seen by many as tax cuts for the wealthy.

Reaction was swift and unwelcoming.

“We are extremely disappointed by the Senate bill released today. Despite promises to the contrary, it will leave millions of people without health coverage, and others with only bare bones plans that will be insufficient to properly address their needs,” said Darrell G. Kirch, MD, president and CEO of the Association of American Medical Colleges. “Rather than stabilizing the healthcare marketplace, this legislation will upend it by crippling the Medicaid program while also placing untenable strain on states and providers.”

“The Senate proposal would likely trigger deep cuts to the Medicaid program that covers millions of Americans with chronic conditions such as cancer, along with the elderly and individuals with disabilities who need long-term services and support,” added AHA president and CEO Rick Pollack. “Medicaid cuts of this magnitude are unsustainable and will increase costs to individuals with private insurance.”

Although the bill seems to have a snowball’s chance in the summer of passing the Senate as is, it still raises concerns for those who stand to lose healthcare coverage or Medicaid reimbursement. Four Republican senators — enough to kill passage of the bill — are withholding support, but they are open to negotiations that would eliminate the ACA completely. This is unlikely -- but in this current climate, the outcome is unclear.