American Society of Plastic Surgeons
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FEDERAL | ASPS’s Role in the MACRA Rulemaking Process

In 2015, Congress passed landmark legislation repealing the deeply flawed Sustainable Growth Rate (SGR). In its place, the Medicare Access and Chip Reauthorization Act (MACRA) was passed. While this legislation worked its way through Congress, ASPS asked Congress questions targeted at ensuring that the legislation would achieve the admirable goal of providing true opportunities for improvements in quality of care and resource use, rather than becoming a series of meaningless steps that would not result in improvement for patients and would only serve to increase administrative burden.

After the bill passed, CMS solicited comments from the healthcare community and public through a Request for Information (RFI) on the Implementation of the Merit-Based Incentive Payment System (MIPS) and Promotion of Alternative Payment Models (APMs). ASPS submitted an 18-page response to CMS's RFI and continues to work with CMS to provide valuable input during the MACRA rulemaking process. Our response laid out concerns with respect to 34 separate components of the program. Key points that ASPS made include: (1) the Merit Based Incentive Payment System (MIPS) must have highly relevant, high-quality measures for specialists; (2) CMS should support the work of medical specialty societies to improve upon the current inadequate measures; and (3) CMS should release funding included in MACRA for development of quality measures and for technical assistance to help small practices comply. The Alliance of Specialty Medicine also submitted a response to the RFI on MIPS and APMs, which ASPS participated in. Additionally, ASPS joined the AMA in requesting that CMS and the Department of Health and Human Services release the funding allocated for quality measures development by MACRA in May 2015. There still has been no indication from CMS of the timeline for when these funds might be released.

A year since passage, Congress continues to exercise oversight during the MACRA implementation process. Its latest effort at doing so was through the House Energy & Commerce Committee Subcommittee on Health Hearing on March 17. During this hearing, Congress posed a number of questions to Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality. In advance of this hearing, ASPS and the Alliance for Specialty Medicine submitted comments to the subcommittee members and staff to pose to Dr. Conway. ASPS's questions generally focused on ensuring that plastic surgeons and solo and small-practice physicians are not precluded from meaningfully participation in Medicare once MACRA is fully implemented. Dr. Conway expressed that physician input is necessary for successful MACRA implementation. However, to date, progress toward this goal has been slow moving. CMS has been soliciting feedback from physician specialties, but there has been little advancement made toward incorporating this feedback.

Since the hearing, ASPS continues to engage with CMS during MACRA rulemaking. CMS recently released a draft rule: Expanding Uses of Medicare Data by Qualified Entities. This proposed rule does not attempt to implement Section 105(b) of MACRA. This is problematic, because Section 105(b) directs CMS to share Medicare claims data with Qualified Clinical Data Registries, "for purposes of linking such data with clinical outcomes data and performing risk-adjusted, scientifically valid analyses and research to support quality improvement or patient safety." ASPS has partnered with the Physician Clinical Registry Coalition to urge CMS to develop new policies or procedures to implement Section 105(b).

ASPS will continue to engage with CMS to guarantee plastic surgeries' issues and concerns are voiced and that relevant quality measures are developed for our specialty. Additionally, ASPS will work with Congress to guarantee that MACRA is being implemented in a way that will actually reward value over volume.