High Stakes

Below the Radar: Two Key Healthcare Policy Issues to Watch

Off Radar: Two Key healthcare policy Issues to Watch

For the past few months, the heated debate over repeal and replacement of the Affordable Care Act has dominated the agenda in Washington, D.C. That won’t change anytime soon, but there are potentially significant healthcare policy issues flying below the radar right now. Here are a few thoughts on two of those issues.

The Centers for Medicare & Medicaid Services (CMS) continues to implement requirements under a bipartisan 2015 law known as the Medicare Access and CHIP Reauthorization Act (MACRA). It abolished a clunky Medicare reimbursement formula for physicians and created an incentive-based system built on reported quality outcomes. Briefly, MACRA’s Quality Payment Program creates two reporting tracks for physicians: the Merit-based Incentive Payment System (MIPS) and an Advanced Alternative Payment Model (APM) for delivery systems such as a medical home or accountable care organization. Those under MIPS in 2017 may receive a positive payment bump if they submit data for the full year. Those in an APM as of 2017 could receive a 5% payment incentive beginning in 2019, and that would gradually increase to 9% in 2022 and beyond.

CMS is allowing physicians to report at their own pace this year after providers worried about the difficulty of absorbing the new system. But there is pressure on CMS to make other tweaks to the program, and a new Quality Payment Program regulation is expected soon. The Medicare Payment Advisory Commission (MedPAC) has argued that some MIPS quality measures create a reporting burden that outweighs the value of the data they contain and aren’t likely to move Medicare toward better care delivery. Instead, MedPAC suggests it may be better for CMS to drive physicians toward APMs by capping the maximum bonus under MIPS, eliminating a $500 million bonus pool for “exceptional performance” and making it more attractive for small practices to choose an APM by offering a two-sided risk model.

Candidly, CMS is walking a tightrope on MACRA because the new payment system must accommodate 300,000 physicians of different practice sizes and types while prodding physicians into value-based models like ACOs that, relatively speaking, are in their infancy. Expect a combination of continued flexibility for small and rural practices coupled with more accelerated development of APMs for physicians who are ready for them so Medicare can gradually shift more patients into value-based models.

As we all know, not all significant healthcare activity occurs at CMS. But if you have never heard of the Consumer Financial Protection Bureau (CFPB), you probably aren’t alone. Created by the Dodd-Frank Act, CFPB is a consumer watchdog with sweeping authority to regulate everything from credit cards and payday loans to debt collectors – including those that collect medical debt. The Bureau is preparing to issue a regulation regarding debt collection practices and, in the meantime, CFPB continues to pursue individual cases involving alleged deceptive conduct by debt collectors. There have been consent decrees and other actions involving medical debt collection and that net could widen under a proposed regulation. In other words, CFPB matters to your back-office functions.

Critics of the CFPB say it is guilty of overreach in its zeal to protect consumers and the Bureau faces a May 24 court hearing as part of a legal challenge that the Trump Administration has joined. One of the most vocal critics is Jeb Hensarling (R-TX), who happens to chair the House Financial Services Committee. Hensarling’s “Financial Choice Act” would refashion the CFPB as the Consumer Law Enforcement Agency to eliminate its authority to regulate “unfair, deceptive or abusive acts and practices,” give the President the option of removing its director, subject it to regular congressional review and force it to compete annually for appropriations. The bill has survived a committee markup and is likely to win approval in the House. Its prospects are less certain in the Senate, where Democrats – including fierce CFPB advocate Elizabeth Warren (D-MA) – oppose changes they say will defang the Bureau and gut Dodd-Frank.

So, it might be wise to add the acronyms “MACRA” and “CFPB” to your healthcare alerts. In the wacky world of healthcare policy, they may end up being as relevant to you as repeal and replace.

Written by guest blogger Keith A. Snider of Health Policy Source Inc.

Keith A. Snider serves as Healthcare Policy Director with Jarrard Inc.’s strategic ally Healthcare Policy Source Inc., where he concentrates on monitoring legislative and regulatory activity, crafting policy memorandums and issue briefs, and providing legislative and regulatory analysis, as well as client advocacy services. Prior to joining the firm, Mr. Snider spent five years as a journalist with Bloomberg News in Washington, D.C., where he covered the hospital, managed care, and medical device industries. He was previously the lead healthcare journalist at The Tennessean in Nashville, covering such areas of interest as the for-profit hospital industry, healthcare venture capital investing in the Southeast, and efforts to reorganize TennCare.


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