Analysis: Don’t Expect Trump To Save Physicians From MIPS
The Affordable Care Act (ACA) has gotten most of the attention after the election of Donald J. Trump made it a near-certainty that the law won’t survive in its current form – but your practice and daily workflow is more heavily impacted by a much lower-profile law, the Medicare and CHIP Reauthorization Act (MACRA).
MACRA, which includes the Merit-based Incentive Payment System (MIPS) is wholly separate from the ACA and is unlikely to see major changes, experts tell The Business of Medicine. “MACRA as a whole is just less of a partisan issue,” says Jack Hoadley, research professor at the Georgetown Health Policy Institute in Washington. “The interest in value-based approaches is not particularly Republican or Democratic. People from both sides of the aisle have been interested in moving away from the pure fee-for-service model.”
That’s actually good news for many practices that have invested time and resources into preparing for MIPS, says Joel James, director of public and government affairs at Signature Medical Group, a large, independent multispecialty group based in St. Louis, Mo. “There could be some tweaks to MIPS, coming from within CMS, and we’re hopeful to see things like a better definition of what an advanced alternative payment model is, so more physicians can participate in APMs.”
Trump’s HHS pick ‘very positive’ for physicians
With Congress unlikely to touch the MACRA legislation, the incoming HHS secretary will have considerable leeway to make changes to MIPS. The president-elect has nominated Rep. Tom Price (R-Ga.), a former orthopaedic surgeon who has previously introduced legislation to replace the ACA, to be HHS secretary.
“My personal feeling is that he will be very positive for physicians, he’s going to be very physician-focused, especially for practice-based physicians, because he knows what that’s like,” says James, who has worked with Price on a variety of physician advocacy issues in the past. “I know folks are concerned that Dr. Price is opposed to bundled payments and value-based care, but that’s not really accurate. He’s opposed to CMS acting on its own authority to make some of these programs mandatory.”
For example, in his capacity as a member of Congress, Price has railed against the Comprehensive Care for Joint Replacement Model (CJR), saying that the program came with “tremendous risk and complexity for patients and healthcare providers,” while decrying the fact that CMS made it mandatory. The agency had overstepped its bounds in pushing such a model so quickly on orthopaedic providers, Price argued in a letter to Andy Slavitt, the acting CMS administrator.
Much more will be known after Price is confirmed as HHS secretary, if his nomination can pass the Senate. What seems certain, however, is that your plans to prepare for the first MIPS performance year will need to continue as scheduled. For detailed guidance on your options to tackle the 2017 performance period, refer to the November issue of The Business of Medicine.
— Grant Huang, CPC, CPMA (firstname.lastname@example.org). The author is Director of Content at DoctorsManagement.