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MGMA to Price: Simplify MACRA, Reassess Alternative Payment Models

MGMA urged new HHS Secretary Tom Price to reduce regulatory burdens, streamline MACRA, and slow down the transition to Alternative Payment Models (APMs).

MGMA asks HHS to reassess APMs

Source: Thinkstock

- MGMA would like HHS Secretary Tom Price to reduce the regulatory burdens of HIPAA and MACRA, reassess the development of Alternative Payment Models (APMs), and postpone implementation of the ONC’s 2015 Certified EHR criteria, the organization said in an open letter.   

President and CEO Halee Fischer-Wright, MD, MMM, FAAP, CMPE, outlined four major objectives that would encourage administrative simplification and provide financial relief to healthcare providers across the industry.

Simplify administrative costs and cut regulatory waste

HIPAA has not been effective for reducing administrative overhead between providers and health plans, MGMA believes, citing $300 billion in administrative expenses which account for 15 percent of US healthcare spending.

Based on the high spending and physician frustrations that still exist under HIPAA, MGMA advised Price to directly engage with healthcare leaders to establish appropriate administrative standards to cut costs and reduce physician constraints.

“More than twenty years after the passage of HIPAA, several critical standards have yet to be promulgated by the government, while others have not been updated or are simply not enforced,” MGMA stated. “This has led to a continuation of manual administrative processes that, if corrected, could save the healthcare industry billions of dollars.”

Decrease the burdens of the Merit-Based Incentive Payment Systems (MIPS)

Despite HHS promises that MIPS would reduce reporting burdens and consolidate multiple quality initiatives into one simple program, MGMA asserts that the four internal components of MIPS will still keep data siloed and reporting burdens high.

“This approach is extremely burdensome and incompatible with both the intent of Congress and the Department’s goal of reducing the cost of healthcare,” MGMA said. “According to a 2016 Health Affairs study, physician practices in four common specialties spend, on average, 785 hours per physician and more than $15.4 billion per year on external quality reporting requirements.”

MGMA believes that MIPS can be optimized with a 90 day reporting period, and also suggests that the rewards for MIPS attestation should be more tailored towards care quality than reporting volume.

Work more directly with providers to develop Alternative Payment Models

MGMA recommends a careful review of risk-bearing payment models  to address potentially misaligned financial incentives between fee-for-service reimbursements and APMs eligible under MACRA.

“In a noteworthy analysis of MGMA data from medical groups that transitioned from fee-for-service arrangements to capitation in 1996, groups faced reductions of up to 30% of revenues due to competing incentives in these contracts,” MGMA said.  “Activities that would maximize fee-for service income cut into profit from risk-bearing payment arrangements, while the reverse occurred when groups attempted to manage utilization.”

The organizations also encouraged Price to involve physicians more directly in the process of developing and implementing APMs.

“We...believe the goal of MACRA to support practices in transforming their care delivery models from fee-for-service to value-based is best accomplished by working directly with the physician community to design APMs.”

Postpone ONC’s upgraded EHR certification requirements

While MGMA acknowledges that meaningful use helped increase EHR adoption, the organization also contends that the ONC’s EHR certification program reduced EHR usability and cost effectiveness.

Based on industry perceptions of poor interoperability and the lack of EHR benefits, the MGMA believes the ONC should  delay the requirement to move to the 2015 EHR Certification criteria in order to give providers more opportunities to develop interoperability and achieve ROI with their current software tools.

“Despite widespread use of EHR technology, and the outlay or more than $30 billion dollars in federal incentives, the industry has also not yet achieved the level of interoperability that would result in significant clinical and administrative improvements promised at the outset of the federal incentive programs.”

MGMA concluded by expressing its willingness to work with Price to make necessary changes to regulations.

“We look forward to continuing to work with you and others at HHS to advance constructive solutions to improve health and health care in America,” the letter said.

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