Government Advocacy

June 3, 2019: MGMA urges Congress to improve MACRA

Advocacy Letter

June 3, 2019        
The Honorable Mitch McConnell
Majority Leader
United States Senate
Washington, DC  20510 

The Honorable Charles Schumer
Minority Leader
United States Senate
Washington, DC  20510 
The Honorable Nancy Pelosi
United States House of Representatives 
​Washington, DC  20515 

The Honorable Kevin McCarthy 
Minority Leader
United States House of Representatives 
Washington, DC  20515 
Dear Leader McConnell, Leader Schumer, Speaker Pelosi and Leader McCarthy: 
Since the enactment of the Medicare Access and CHIP Reauthorization Act (MACRA), the undersigned organizations have worked closely with both Congress and the Centers for Medicare and Medicaid Services (CMS) to promote a smooth implementation of the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). While MACRA represents an improvement over the flawed sustainable growth rate payment methodology and legacy quality and cost reporting programs, its implementation has been a significant undertaking for CMS and physicians. We strongly supported the improvements to MACRA included in the Bipartisan Budget Act of 2018, which allowed for a more gradual transition into the program and helped many physician practices avoid penalties they likely would have otherwise incurred under the MIPS program. However, further refinements are needed to improve the program and ensure physicians can be successful going forward. 
In order to foster the continued success of MACRA, we urge Congress to implement positive payment adjustments for physicians to replace the payment freeze over the next six years, extend the Advanced APM bonus payments for an additional six years, and implement several additional technical improvements to MACRA, which are outlined below.  
Implement Annual Positive Payment Updates  
MACRA included modest positive payment updates in the Medicare Physician Fee Schedule, but it left a six-year gap from 2020 through 2025 during which there are no updates at all. Following this six-year freeze, the law specifies physician payment updates of 0.75 and 0.25 percent for physicians participating in APMs or MIPS, respectively. By contrast, other Medicare providers will continue to receive regular, more stable updates. As physician practice payments fall increasingly below their costs, patient access issues would arise.

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