Physicians told lawmakers Tuesday they're eager to adopt value-based payment models under the Medicare Access and CHIP Reauthorization Act but also warned the transition will be difficult and disruptive to patients.
Doctors need to have robust and interoperable electronic health records and options for treating patients beyond face-to-face meetings, advocates told the House Energy and Commerce Committee's Health Subcommittee. They also said MACRA regulations should be flexible so that practices can find what works best for them. A large hospital system will have needs that are vastly different from those of a solo practitioner in a rural area.
Dr. Jeffery Bailet, co-president of the Aurora Health Care Medical Group in Wisconsin, said interoperability of EHRs needs to improve and that the CMS should thin out its IT reporting requirements to remove duplication. Practices need more than just an EHR, they need an infrastructure that will allow them to analyze data and use it to improve, he said.
“It's going to take time to build all that infrastructure initially ... and my concern is we cannot move too quickly,” he said.
MACRA replaced the sustainable growth-rate formula with the Merit-based Incentive Payment System that bases payment increases on quality measures, combining parts of several other Medicare quality initiatives and the incentive program for the meaningful use of EHRs. The law will also allow providers to opt out of MIPS and receive enhanced rates beginning in 2019 if they participate in alternative payment models.
Dr. Barbara McAneny, immediate past chair of the American Medical Association, said doctors need room from some trial and error in determining what payment models and health record systems will work best for them. That means time and money to make changes while continuing to serve patients. “Don't put us out of business while we're trying to make it work,” she said.
Rep. Michael Burgess (R-Texas), who is a physician, said the 21st Century Cures Act, which passed in the House and has been divvied up into several Senate bills, calls for creating national standards for health IT that will allow for comparing and exchanging records.
“Please don't think we've taken our eye off the ball in terms of interoperability,” Burgess said. “It remains an important factor to achieve.”