2016 TMA and ACMQ Texas Quality
Summit November 18-19 Austin
and Council on Socioeconomics Chair John Carlo, MD, also had Mr. Gronni- ger’s ear. Dr. Read echoed Dr. Snyder’s re-
marks and reinforced the message TMA sent to CMS in the association’s formal comment letter on the draft MACRA rule. Read the letter at tma
.tips/MACRAcomment. “We are light-years ahead of small
practices, which are in survival mode all the time, in terms of reporting qual- ity,” Dr. Read, head of the 14-physician Texas Colon & Rectal Specialists, told Mr. Gronniger. “All these small prac- tices are doomed to fail under this system. It’s not worth their spend- ing money to participate in a system where they’re going to fail.” The chief congressional sponsor
of the MACRA bill — a physician and a Texan — reminds doctors, however, that the chances and costs of failure are much lower than they would have been without the new law.
Register today:
texmed.org/qualitysummit
“NEITHER SIMPLIFIED NOR IMPROVED” Physicians cheered when Congress passed MACRA in April 2015, primar- ily because it finally eliminated Medi- care’s hated Sustainable Growth Rate (SGR) formula. The law also promised to consolidate and simplify a contort- ed web of Medicare programs that measure physicians on their cost and quality of care, as well as their “mean- ingful use” of EHRs. “Eliminating the constant threat of
Medicare payment cuts means that we can focus our energies on improving this new law,” then-TMA President Austin I. King, MD, said on the night MACRA passed. “We can focus our energies on removing the bureaucrat- ic impediments that get in the way of good patient care.” A constant TMA refrain since CMS published the draft MACRA rule on May 9, 2016, is “not what Congress ordered.”
+ 42 TEXAS MEDICINE September 2016
MACRA “promised to simplify and
improve Medicare’s costly and com- plex programs that purport to mea- sure the quality of care we provide to our patients,” Dr. Read wrote in a prominent national health care blog.
“Unfortunately, as we review the draft implementing rule, it appears that the net result will be neither simplified nor improved. “When MACRA legislation was enacted, TMA had no reason to ex- pect CMS would propose to continue flawed concepts from the current quality programs along with plans to diminish a physician’s worth down to a complex point system. More disappointing is to learn that CMS proposes to design a program that is stacked against solo physicians and small group practices in its first year of implementation.” (See “A Game You Cannot Win,” page 44.) The concern for small practices
stems in part from a now-infamous table CMS published in the draft rule. Based on physicians’ performance under the current Medicare measure- ments, Table 64 estimates 87 percent of solo practitioners, 70 percent of eligible clinicians in practices with two to nine eligible clinicians, and 59 percent in practices with 10 to 24 eli- gible clinicians would see their Medi- care payments cut in the first year of MACRA.
Although CMS has dismissed Table
64 as based on outdated data, TMA staff ’s evaluation of the proposed rule finds plenty of reasons for small practices to worry. “TMA analysis finds that small practices frequently will face a lose/lose scenario in which they either incur more cost than they can expect to receive in financial re- wards, or they absorb the crippling penalties and abandon any effort to comply with program requirements,” staff wrote in a comprehensive “Texas Medical Association MACRA Position
TMA MACRA Resource Center:
www.texmed.org/MACRA
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