The Congressional Role in Advancing National Payment and Delivery Reform

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was designed with the intention of creating a national incentive architecture supporting Medicare providers in transitioning away from fee-for-service payments to accountable care models. MACRA sought to fix the broken Sustainable Growth Rate (SGR) process by providing more predictable payment updates and accelerating the adoption of value-based approaches through two payment pathways: the Merit-Based Incentive Payment System (MIPS), which assesses clinicians on their quality of care, promoting inoperability, practice improvement, and costs, or advanced versions of Alternative Payment Models (APMs), which aggregate payments across services and providers and have similar performance requirements.  

While meaningful progress has been made in terms of adoption of APMs, health information technology, and new care models, the limitations of MACRA have become more apparent and the COVID-19 pandemic underscores the need to transition to accountable care. Recent changes to the Medicare Physician Fee Schedule (MPFS) have again resulted in annual Congressional action. As we approach the 10-year anniversary of MACRA’s passage, it is necessary to explore opportunities to improve upon the program to accelerate progress in APM adoption. Regardless of the final dollar amount or technical component, it is imperative that MACRA reforms support collective movement across the health care system towards accountable care goals. 

In this white paper, Duke-Margolis researchers outline four key principles to focus MACRA reform efforts: 

1. Prioritize moving providers into Total Cost of Care models 
2. Ensure meaningful opportunities and incentives for specialist engagement with APMs 
3. Reduce burdensome requirements through alignment with broader CMS strategy 
4. Better utilize CMMI to advance accountable care goals 

Building consensus around MACRA reform efforts that align with these principles is key to catalyzing progress towards expanding accountable care across the health care system and help foster patient-centered, affordable care for all beneficiaries.