Andy Slavitt’s Comment: Keeping Medicare’s Assurance with MACRA

A distinctive way to understand the context behind MACRA.

We’ve started on reforming the delivery system so that value based care can reach every community in USA in order to build on the foundation. Given this intensity of change, I inquired the team to approach MACRA differently. The CMS team was keenly eager to get to work on implementation after this historic legislation approved. But something different from me was heard by them. Stop writing, get out of DC, and start listening. 

Through 4,000 formal remarks, almost 100,000 attendees at our events across the nation, workshops, focus groups, design sessions, physician office visits (and countless tweets), we got a chance to hear sufferers and clinician opinions on things we can do to make healthcare actually better for them.

• We heard from clinicians who challenged and provoked us to show that MACRA and the Quality Payment Program was not one more check-the-box program and rather permits them to concentrate on care and quality improvement
• We heard the deep commitment and devotion that both patients and clinicians have to the Medicare program, but also several frustrations.
• We heard the patients who were fed up from lugging around or repeating their treatment history — who needed more time with a physician who knows them personally, so that they can get the correct treatment at the right time without unimportant repetition or miscommunications.
• We heard from physicians who’re fed up that their electronic health records don’t support patient care. Clinicians need technology that make their jobs more convenient, match their workflows, and provide them access to required information.

Accountability or quality or costs or whatever euphemism individuals use, is not our major challenges. It is to recognize that the path forward is not through any one model or new 3-letter acronym or quick fix, but by dealing the basic things, which lead to bad results, physician burnout, or for sufferers, specifically needier ones, to feel displaced and not get the correct care.
It isn’t to execute a new scorekeeping system by merging an opportunity with MACRA. If we do that, we won’t only miss the chance to transform, but we will add complications to an already overly complicated system.
We made key changes to how we approached this program holistically based on what we heard.
1st: A lighter touch and less regulation were the major things to observe. By accepting and adopting the idea that we can make more progress if we simplified and decreased what was measured and provided physicians back more time with patients and rather supported their quality attempts. And, we decreased the number of requirements in half to assist level the playing field for small or independent practices.
2nd: We came to realize that MACRA is first experience of many clinicians with reporting and paying for quality for the very 1st time. Multiple timelines were created by us to permit clinicians to select their own pace of entry and development.
3rd: We built more opportunities for clinicians and to permit more innovative models to flourish after identifying that several practices are advanced and ready to go further, We assume that about 25% of eligible Medicare clinicians will be in an Advanced Alternative Payment Models by the year of 2018, and we’ve an aim of creating options for physicians in entire specialties and geographies in case to permit them to pick models that are suitable for them.
We all need to keep building on what works while systematically claiming improvement where we can do better as we move forward.

So how do I recommend we combat the next opportunities?
​​First. Build from a foundation of progress, not head backwards. Without building on the foundation of reaching universal coverage, there can be no delivery system reform. That means building on the record twenty million individuals who’ve newly found coverage and continuing the security and protections Americans have found, involving no-cost preventive care, the eradication of lifetime and annual coverage limits, and the end of pre-existing condition exclusions. If we require fixing how care is delivered, so that we’re giving value, then we must make sure that Americans can afford and access quality care at every point in their lives. If we lose even few of the coverage gains made under the ACA, or leave individuals in limbo, people will lose access to regular care and we’ll drive up long-term costs. This does not mean we should not improve how coverage works in a bipartisan fashion. We must always do that and we should now as new leaders bring new approaches and solicit new concepts.
Second. Assert that modernization of Medicare must really mean modernization. By ingenuity, innovation, teamwork, mutual cooperation and the use of information and technology and not by changing funding formulas, progress is achieved.
I will say this bluntly: Without a CMS Innovation Center that can move quickly to establish and expand new approaches to paying for care, MACRA cannot work as well. The advanced alternative payment approaches could slow significantly by having changes to the Innovation Center. We’ll have a much narrower path with fewer specialty options and approaches, which take in patient and physician response and feedback. Commercial payers and Medicare would then fall further out of alignment, and more significantly, less sufferers would have access to innovative care methods.
Third. Initiate to demand technology that can exchange data, that supports care, and that is affordable. MACRA is a chance to move the focus away from paperwork and reporting and towards paying for what works. Electronic health records became an industry before they became a beneficial tool for a variety of reasons. The technology community must be held accountable and answerable by their customers and make room for latest innovators and to provide clinicians more freedom and more flexibility to concentrate on their patients, to practice medicine, and deliver better care. We worked with physicians alongside to design technology tools (QPP.cms.gov) and a support center that permits physicians to learn about, access, and even design their involvement in the Quality Payment Program.
Fourth. Always remember that people are the heart of every policy made. We’re on a journey as a nation towards better health for all. Patients. Care givers. Consumers. Observe MACRA as an initiative or step in the journey to develop care together.