Nearly 30 physician leaders of the California Medical Association (CMA) traveled to Capitol Hill last week for the American Medical Association (AMA) National Advocacy Conference to lobby Congress about the associations' top health care priorities. CMA physicians also met with the leadership of the Centers for Medicare and Medicaid Services (CMS), who are responsible for implementing the Medicare payment reform legislation (MACRA) and the California “GPCI fix” that will overhaul California’s outdated geographic payment localities.

The group met with 25 members of Congress and 40 staff members, lobbying for meaningful use simplification, Medicare recovery audit contractor audit reform, prescription drug cost reduction for patients, rational ways to curb the opioid epidemic and the need to reverse the U.S. Department of Education’s regulation that excludes California physicians from the public service loan forgiveness program.

CMA representatives also met with several CMS leaders, including Patrick Conway, M.D., MSc, CMS chief medical officer and deputy administrator of the CMS Innovation Center. Dr. Conway is overseeing the implementation of MACRA's alternative payment models. The group also met with the CMS staff responsible for implementing MACRA's Merit-Based Incentive Payment System (MIPS).

The meeting with CMS was productive and encouraging. CMA leaders emphasized the need for CMS to simplify and reduce the administrative burdens in the meaningful use program and the Physician Quality Reporting System. Dr. Conway expressed a clear understanding of the problems physicians are experiencing with the current reporting programs. He told the group that he believes CMS will significantly improve those programs under the new MIPS regulations due out this spring.

CMA also urged CMS to open the pathway for multiple physician-led alternative payment models (APM). Dr. Conway noted that CMS is looking for a broad range of APMs to be submitted by physicians. The conversation led CMA to believe that APMs would not be limited to proven accountable care organizations that are accepting significant financial risk, as previously thought.

On the APMs, CMA urged CMS to provide physicians participating in APMs with total cost of care data for attributable patients to help them better manage their costs. Most importantly, CMA asked that any APM start-up costs and ongoing administrative costs be part of the downside financial risk calculations. Otherwise, only hospital-led systems would have the capital to participate.

Dr. Conway clearly understood that individual physicians and small physician groups would not be able to accept the same level of risk, and encouraged CMA to continue to weigh in on these important issues.  

CMA also reported that many national specialty organizations are aggressively developing APMs for submission to CMS. However, CMA told Dr. Conway that several specialties had reported that they could not meet the statutory requirements for APMs for various reasons, and the group pressed CMS to explore these barriers.

CMA will remain vigilant and actively involved in MACRA implementation on behalf of California physicians.

Contact: Elizabeth McNeil, (800) 786-4262 or emcneil@cmadocs.org.