AMA CEO: Flawed SGR No Longer Threatens Payment Delivery
By - James L. Madara, MD, Chief Executive Officer and Executive Vice President of the American Medical Association (AMA), provided insight via a morning media conference today on the organization’s perspective regarding the Senate’s overwhelmingly favorable 92 to 8 vote in approval of the Sustainable Growth Rate (SGR) repeal and the greater impact of this on healthcare delivery.
Madara says the Medicare and CHIP Reauthorization Act (MACRA) eliminates the flawed SGR formula healthcare system, allowing physicians to enact innovate delivery and payment reforms to improve the overall quality of care while decreasing costs.
The AMA has launched a wide variety of ambitious initiatives aimed at improving the nation’s health, says Madara, congratulating Congress for merging together in a bipartisan, bicameral way and affirmatively interacting to enact positive change.
“It’s not surprising that this happened because it’s also true that what this bill does is ensure access to care for our seniors, military personnel and their families, and children and low income adults,” states Madara, who emphasizes AMA shines a light of congratulation upon Congress.
“The elements in the bill align with the American Medical Association’s really ambitious goals toward improving the health of the nation,” says Madara.
Madara confirms such a foundation is one AMA has been building upon for many years, as this bill greatly facilitates a success-focused outcome.
“We can shift to working with all levels of government toward policies that allow access to affordable quality care, lower health costs,” Madara confirms. “With the SGR behind us, we can now work toward those other elements with Congress, CMS, and others, putting the patients first and ensuring access to care, looking to reduce overall costs, and improving healthcare quality.”
Regarding the positive effects of the bill, Madara states, “This flawed SGR formula really was a threat to access to care for patients. It was also a threat to practice stability and therefore an inhibitor to investment in practices toward new payment delivery systems.”
These threats have now been eliminated, says Madara.
“There are a lot of evolving issues to take care of in this migration toward models of payment delivery that are more positively impacting quality of care,” explains Madara. “It’s also simultaneously true that anytime a complex bill is passed, there are implementation problems that sometimes arise.”
Madara confirms the AMA will be keeping its finger on the pulse of the implementation and will actively collaborate with the federal government within both the short term and the long term to make sure that data is correctly tracked.
“This issue of SGR which we’ve been working on for a long time sometimes overshadowed the fact that we work equally hard toward improvement payment delivery systems, providing and identifying a series of promising models that physicians could use,” Madara explains. “This allows a brighter light to be shined on these other elements of moving payment delivery and quality forward toward lower costs and better health for our nation.”
Madara says patients are in the midst of a grand experiment as the healthcare industry considers how to best measure quality issues.
“I think this was a recognition that there were problems and inhibitions in moving forward tracking back to this formula,” Madara confirms. “I think it was a global realization that happened slowly over time that exposed how flawed this was in the thinking as we’re trying to move toward this new environment of better health, better healthcare at lower cost.”
Madara confirms another positive of this passing legislation is an increased level of flexibility within the healthcare industry at large, which is resultantly set up rather well to provide better care at lower costs.
“One can find a way to latch onto systems that improve and reward quality. One can do that in an independent practice, in an ACO, in a group of a varying size. It recognizes the fact that we’re not a one-size-fits all nation,” confirms Madara.
Regarding the alleged aftermath of Medicare Access and the CHIP Reauthorization Act, Madara confirms it is a significant improvement over the current set of measurements, whether they are value-based, a Physician Quality Reporting System (PQRS), Meaningful Use, etc.
“Those collections of measures were developed in a well-meaning but somewhat disconnected way,” confirms Madara. “They’ve been applied. They have lots of problems.”
Relating these concepts to recent RAND studies, Madara says, “These studies tend to show physicians really respond to measures that relate to real quality and real improvement of outcomes in their patient groups. Getting this right provides us natural incentive that drives physicians and the MIPS program is a great step forward compared with what we face currently.”
Madara concludes that AMA’s overarching goal is to improve the health of the nation and maintains this bill allows the healthcare industry to move in an advantageous direction by removing financial impediment and improving the overall internal structure of the industry.
