American Society of Plastic Surgeons
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FEDERAL | Congress Intensifies Oversight of the MACRA Implementation Process

Over the past few months, ASPS has engaged in aggressive advocacy to protect plastic surgeons' interests in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) implementation process. ASPS has raised a number of concerns with how the Centers for Medicare and Medicaid Services (CMS) is implementing MACRA through federal Fly-Ins, by engaging in the Congressional oversight process and by commenting directly to CMS on the MACRA proposed rule.

Southeast and Midwest Fly-in and Essentials of Leadership Fly-In

In April and June, 35 ASPS members visited Capitol Hill to discuss issues that are important to plastic surgeons and their patients with members of Congress and their health staffers. In total, ASPS conducted eighty-eight meetings, which were primarily focused on expressing ASPS's concerns over the implementation of MACRA. ASPS's concerns with how CMS is handling MACRA and the negative impact it could have on providers were echoed by many members of Congress, who are interested in continuing to work on this issue.

Response to CMS's MACRA Proposed Rule

CMS published the MACRA proposed rule in May. ASPS commented in response outlining plastic surgery's specific issues with how the rule could negatively impact plastic surgeons, as well as physicians practicing in solo or small practices. ASPS also participated in comments drafted by the Alliance of Specialty Medicine (ASM), the American Medical Association (AMA), the Physician Clinical Registry Coalition (PCRC), the Medical Group Management Association (MGMA), the Council of Medical Specialty Societies (CMSS), and the American College of Surgeons (ACS). Currently, ASPS continues to engage directly with CMS and is drafting additional MACRA comments on patient relationship categories and codes.

Participation in the Congressional Oversight Process

On June 13th, the Senate Finance Committee (Committee) held a hearing titled, Medicare Access and Chip Reauthorization Act of 2015: Ensuring Successful Implementation of Physician Payment Reforms. During this hearing, CMS Acting Administrator Andy Slavitt testified on the MACRA implementation process. The Committee expressed serious concerns regarding the impact that MACRA will have on small and solo practices and practices located in rural areas. ASM submitted testimony on behalf of specialty medicine, and ASPS submitted written testimony expressing issues over three specific areas in the MACRA law, Section 101(e), Section 102 and Section 105(b) that CMS has failed to or has expressed an unwillingness to implement:

SECTION 101(e) of the law creates a new Physician-Focused Payment Technical Advisory Committee (PTAC) to provide recommendations to the Secretary of Health and Human Services on the development of new physician-focused alternative payment models. Late in 2015, CMS staff stated in public forums that it is "under no statutory obligation" to follow the recommendations of the PTAC.

SECTION 102 of the law directs the Secretary to provide $15 million annually to support the development of physician quality measures, beginning in FY15. FY15 came and went without these funds being released, FY16 is nearing its end, and CMS has given no indication of when they will be made available.

SECTION 105(b) of the law directs CMS to share Medicare claims data with Qualified Clinical Data Registries (QCDR) to support quality improvement and patient safety. Earlier this year, CMS stated that it intended not to implement this provision. This month, CMS released a Final Rule partially implementing this section in a manner that will not permit QCDR's to access real-time Medicare claims data.

During this hearing, CMS Administrator Andy Slavitt indicated that CMS is open to delaying MACRA implementation, although no formal announcement has been made at this time. ASM, which ASPS is a member of, is supportive of a delayed start date of July 1, 2017. ASPS will continue to work with Congress, CMS and the medical community to try to ensure that plastic surgeons' issues are taken into consideration in the implementation of the law.