The American College of Surgeons (ACS) is actively working with Congress to identify and combat policies that could further administrative burdens on physicians and their practices in order to ensure that the ongoing implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) is accomplished in a way that improves the delivery of medicine for patients.
The Future of Medicare Physician Payment
Federal Efforts
Quality Measures Congressional Sign-On Letter to CMS
For surgeons and their patients, implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) has fallen short on its promise of tying payment more closely to the value of care, typically described as the quality of care received for the cost to produce that care. Under the Merit-based Incentive Payment Systems (MIPS) program, most employed surgeons are ranked based on measures in the CMS Web Interface, which evaluates compliance with primary care actions such as immunizations, blood pressure control, diabetes control, and tobacco cessation. While these measures may be important to a patient’s overall health, they are not meaningful to a patient’s episode of surgical care nor do they facilitate improvement.
Meaningful measurement for surgery exists. The ACS supports surgical quality measurement that includes a combination of three elements: standards-based facility-level verification programs, patient reported experience and outcomes measures, and traditional quality measures including registry and claims-based measures. Together, these three elements provide meaningful episode-based measurement of quality for the surgeon and patient, along with actionable information necessary for improvement.
Following the advocacy efforts of ACS fellows during the 2019 ACS Leadership and Advocacy Summit, several key members of Congress are circulating a letter concerning surgery specific quality measures. The letter, led by Representatives Raul Ruiz, M.D. (D-CA), George Holding (R-NC), Brian Higgins (D-NY), and Larry Bucshon M.D., FACS (R-IN) encourages the Center for Medicare and Medicaid Services (CMS) to work with stakeholders to develop and test a quality framework that focuses on high-value processes, clinical outcomes, and patient reported outcomes and experiences.
ACS Testimonies to Congress on Medicare Physician Payment
On May 8, 2019, Frank Opelka, MD, FACS, Medical Director, Quality and Health Policy, testified on behalf of the ACS before the Senate Finance Committee for its hearing entitled, " Medicare Physician Payment Reform After Two Years: Examining MACRA Implementation and the Road Ahead."
Read Dr. Opelka’s May 2019 testimony
On July 26, 2018, Frank Opelka, MD, FACS, Medical Director, Quality and Health Policy, testified on behalf of the ACS before the Subcommittee on Health of the House Committee on Energy and Commerce for its hearing titled, “MACRA and MIPS: An Update on the Merit-based Incentive Payment System”
Read Dr. Opelka’s July 2018 testimony
On November 8, 2017, Frank Opelka, MD, FACS, Medical Director, Quality and Health Policy, testified on behalf of the ACS before the Subcommittee on Health of the House Committee on Energy and Commerce for its hearing titled, ”MACRA and Alternative Payment Models: Developing Options for Value-Based Care”
Read Dr. Opelka’s November 2017 testimony
ACS Letters to Congress Regarding Medicare Physician Payment
ACS Statement to House Ways and Means Health Subcommittee: The Implementation of MACRA's Physician Payment Policies
ACS Letter on 2018 Bipartisan Budget Act
ACS Letter regarding February 6, 2018 Continuing Resolution
ACS Response to CMS Request for Information related to the Medicare Access and CHIP Reauthorization Act (MACRA)
Additional ACS Payment Resources
2018 MACRA Quality Payment Program—ACS Quality Payment Program Resource Center
Medicare Physician Fee Schedule Rule
ACS Regulatory Relief Asks