access to care. CMA will also work to protect current state and federal health care funding including the Proposition 55 and Prop 56 tobacco taxes. Current CMA policy opposes Medicaid block grants. Moreover, CMA will continue to work to ensure that low and moderate-income families can afford coverage. We have promoted responsible health care financing, including the use of the tax code to help Californians purchase insurance and subsidies to help low-income families afford coverage. An underfunded health care system places unsustainable burdens and unfunded mandates on physicians. It also creates access to care problems, health care delays and economic hardship for patients. CMA will be a voice for patient choice in the new health care system. CMA physicians are committed to the health and well being of our patients. And finally, CMA will fight to maintain the hard-fought insurance reforms that require insurers to dedicate 85 percent of their revenues to direct medical care, community rate and submit premium increases to regulators, as well as prohibit insurers from placing lifetime or annual limits on benefits, blocking coverage for pre-existing conditions or rescinding coverage when a patient becomes ill. CMA has fought health plan mergers over the years to promote an open, competitive health care marketplace in California. CMA also recognizes that the ACA has serious shortcomings that need to be addressed. More than 1 in 3 Californians are now enrolled in the state’s Medi-Cal program yet few have true access to a doctor. Because the Medi-Cal reimbursement rates are among the lowest in the nation, most physicians cannot afford to participate. Moreover, the payment rates and physician networks in the Covered California Exchange are inadequate, and many families continue to express concerns about the affordability of insurance in the Exchanges. The individual market needs more stability, and while the ACA significantly expanded coverage, it did not expand access to care for many Californians. Based on CMA policy, we have developed overarching health care reform principles to guide CMA’s advocacy through the debate. CMA’s overriding goal is to ensure that Californians maintain access to quality, meaningful, affordable coverage.
CMA’S CORE PRIORITIES FOR THE FUTURE OF FEDERAL HEALTH CARE REFORM: 1. 2. 3. 4. 5.
Ensure Californians do not lose coverage or access to care. Improve access to care. Protect state and federal health care funding for Californians. Support appropriate and broad-based health care financing. Continue tax policies and subsidies that help low-moderate income patients afford coverage. 6. Advocate for broad patient choice of physicians, plans and coverage through Health Savings Accounts, private contracting, private insurers and health plans, as well as government programs. 7. Maintain the important insurance reforms that protect physicians and their patients, such as coverage for pre-existing conditions. 8. Stabilize the individual insurance market. 9. Provide access to affordable prescription drugs. 10. Medical liability reform that does not undermine California’s MICRA law.
MEDICARE MACRA UPDATE BACKGROUND
mula and established two Medicare payment tracks from which physicians can choose to participate. The first track allows physicians to participate in Alternative Payment Models (APMs) with a 5 percent bonus for meeting certain EHR and quality standards. APMs must also assume some downside financial risk, except Primary Care Medical Homes. The legislation also allows innovative, alternative Physician-Focused Payment Models to be approved through another regulatory process. The second track is the traditional Medicare fee-for-service payment track with four performance-reporting programs: 1. Quality (formerly known as the Physician Quality Reporting System-PQRS); 2. EHR Advancing Care Information (ACI) (formerly known as the Meaningful Use program); 3. Cost (formerly known as the Value Modifier Program); 4. New category called Improvement Activities (comprised of activities most physicians are already doing). These fee-for-service reporting programs have been consolidated and simplified under a new program: the Merit-Based Incentive Payment System (MIPS). For the MIPS reporting categories, Congress reinstated substantial bonuses and reduced the penalties from current law. The Centers for Medicare and Medicaid Services (CMS) issued the final MACRA implementing rule in October 2016. The new MACRA law and the final rule represent a significant improvement over the previous system. Moreover, CMS is providing a longer transition path for practices to get ready for MACRA. CMA and AMA successfully advocated for a Medicare program that is less burdensome than existing law. Improvements include: • Exempts 30 percent of Medicare physicians. • Longer transition path: Physicians can start reporting on January 1 or October 1, 2017. • No penalties in 2017 if physicians report on one quality measure. • Reduces penalties after 2017. • Reinstates bonus payments. • Eliminates all duplicative quality measures. • Reduces the number of measures by HALF. • Report on six quality measures, five EHR measures, and 2-4 improvement activities. • Fewer requirements for small/rural practices and provides a transition path. • Only need to report on 50 percent of patients for quality. • Eliminates Pass/Fail: Proportional credit given for measures that are met. • More ways to report (claims, EHR, web, QCDR). • Greater selection of applicable national specialty society measure sets. • Funding to help small and rural practices transition. • Allows Alternative Models with reduced financial risk. • Greater enforcement on EHR vendors who are not interoperable. CMA will continue advocacy efforts to relieve physicians from Medicare reporting burdens and for greater accountability and penalties on the EHR vendors that do not meet MACRA requirements. Congress is not likely to take major action on the bipartisan MACRA law in 2017 because CMS delayed MACRA in 2017 and made significant improvements. However, CMA and AMA will continue to be actively engaged with Congress and the Administration to reduce the regulatory burdens on physicians. CMA will also continue to offer programs to educate and assist our members so they can successfully participate. Please see the CMA MACRA Resource Center at www.cmanet.org/MACRA.
In 2015, Congress passed the Medicare Access and Children’s Health Reauthorization Act (MACRA), which eliminated the Medicare SGR forJANUARY / FEBRUARY 2017 | THE BULLETIN | 15