America's physicians are often on the front lines of major change. Changes in clinical standards, technology, industry and government all affect how medicine is practiced, and in turn, the nation's health. To manage that change, healthcare leaders must coordinate to ensure the patient-doctor relationship is preserved and care quality continues to improve.
The last few years contain strong examples of that collaborative progress.
The CMS and the American Medical Association worked in concert to advance a new Quality Payment Program and delivery models to better serve Medicare patients. For more than a dozen years, the deeply flawed sustainable growth-rate payment formula posed a regular threat to patients' access to care and physicians' practices. With the bipartisan Medicare Access and CHIP Reauthorization Act of 2015, the CMS, Congress and other healthcare stakeholders, including America's physicians, at last have a single framework that replaces the flawed formula and the often challenging patchwork of measurement programs. MACRA and its resulting Quality Payment Program were the result of years of hard work, advocacy and bipartisan compromise.
Part of the success of the Quality Payment Program is the CMS' “user-driven policy design” -- an outside-in approach based on an unprecedented effort of listening and learning. As the CMS worked to implement the law last year, it held a listening tour across the country to hear from clinicians and patients first hand. The CMS received over 4,000 comments and had nearly 100,000 attendees at its outreach sessions and town hall meetings. Policy should not be written just by those sitting behind desks, and we should all continue to focus on connecting policy closer to where care happens and obtaining feedback from clinicians on the ground.
This user-driven process is tried and true. Before the Quality Payment Program, the CMS and the AMA worked through the successful implementation of ICD-10 -- a critical set of codes that affects nearly every physician and hospital. People were concerned that physicians in small and rural practices would not be ready by the initial implementation date, and that we were facing a potential crisis similar to Y2K. The CMS took a customer-focused approach and worked closely with the AMA to achieve a smooth transition. The result, like Y2K, was a crisis that never materialized. There was no chaos, and patient care was never affected.
The CMS and the AMA also found common ground this year through innovation to prevent Type 2 diabetes -- a national effort that is one of three strategic focus areas for the AMA. For the past three years, the AMA has partnered with the YMCA on a project in eight states to help increase patient referrals to a pilot testing evidence-based Diabetes Prevention Programs at local YMCAs. The project, which was tested by the CMS Innovation Center, garnered savings of $4.27 million. Based on those evaluations of the pilot and the very real possibility of preventing or delaying the progression to Type 2 diabetes in the greater Medicare population, the CMS acted. Using Innovation Center authority granted by the Affordable Care Act, the agency made the landmark decision to expand coverage of the Medicare Diabetes Prevention Program to at-risk Medicare patients staring in 2018.
The partnership that led to these successes was established early in the Obama administration. The CMS and the AMA worked closely together as the uninsured rate was brought to an all-time low and coverage was extended to more than 20 million Americans as the ACA was implemented. In addition, the CMS and the AMA worked together to ensure that physician-led accountable care organizations were established and collaborated to take best practices from the clinical field and use them to help design CMS Innovation Center payment and service delivery models so that Medicare payments fit how physicians want to practice.
Throughout this administration, and most recently with implementation of MACRA's Quality Payment Program, the CMS has been in constant contact with America's physicians. Physicians have an open channel to suggest ideas and share concerns, and CMS has a direct way to ask questions and listen.
We should all work to continue this collaborative approach that focuses on patient-centered care, reduced regulatory burden, increased pragmatism and real solutions -- like we found in MACRA implementation. As we work toward a healthier nation, physician groups and the CMS should continue to work toward solutions that allow all Americans to access and afford quality care.
