MGMA advocacy spotlight: Regulatory relief

MGMA has long championed administrative simplification and regulatory relief, and over the past year, the Association has positioned itself at the center of the movement to unburden physician practices from excessive federal red tape. We have engaged with key policymakers in the U.S. Department of Health and Human Services (HHS) and Congress to express concerns about excessive regulatory obstacles facing medical group practices and to recommend steps to mitigate these burdens. MGMA has supported our advocacy with the results of a robust membership survey about medical practices’ top regulatory pain points.

The Association continues to advocate for broader relief and will keep members apprised of our efforts at mgma.com/regrelief. 

MGMA lobbies Congress for Medicare red tape relief

The U.S. House Committee on Ways and Means Health Subcommittee launched the Medicare Red Tape Relief Project in July 2017 to relieve physician group practices from the burdens of excessive federal regulations. MGMA submitted three formal recommendations to the subcommittee and participated in an invitation-only roundtable on March 15 focused on identifying existing regulatory barriers to high-quality, low-cost healthcare. 

MGMA’s recommendations included reducing the reporting burden in the Medicare Merit-based Incentive Payment System (MIPS), modernizing fraud and abuse regulations that prevent providers from working together to coordinate care and reduce costs for patients, and standardizing critical administrative processes, such as provider credentialing.

MGMA urges federal regulatory relief

Following President Donald Trump’s executive order directing federal agencies to “cut the red tape” to reduce burdensome regulations, the Centers for Medicare & Medicaid Services (CMS) launched the Patients over Paperwork initiative. CMS Administrator Seema Verma described the initiative as a way for the agency “to focus on patients first. To do this, one of our top priorities is to ease regulatory burden that is destroying the doctor-patient relationship. We want doctors to be able to deliver the best quality care to their patients.” 

MGMA has actively participated in all regulatory reform events hosted by CMS. During an invitation-only meeting with officials from CMS and the Office of the National Coordinator for Health Information Technology (ONC) in early January, both agencies updated MGMA about the Patients over Paperwork Initiative and shared recommendations to further reduce unnecessary red tape in healthcare through streamlining documentation requirements, standardizing transactions and reducing quality reporting mandates. At an invitation-only Cut the Red Tape Summit hosted by HHS on Oct. 2, 2017, MGMA was one of five organizations asked to offer recommendations to reduce unnecessary government regulations.

The Association has also responded to several requests for information about how to relieve medical group practices from the constraints of one-size-fits-all regulations. CMS responded to MGMA’s concerns expressed early in the year about the duration of the MIPS reporting period and lack of eligibility information for 2018 reporting. Read CMS’ response to MGMA at bit.ly/2GAGTdY.

MGMA regulatory relief wins

As a result of these actions, MGMA has seen improvements in the federal regulatory landscape. For instance, the Bipartisan Budget Act of 2018 (Budget Act) added much-needed flexibility to MIPS, Medicare’s physician payment system established by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. The modifications respond to concerns raised by MGMA and other stakeholders and include: 

1. Elimination of MIPS payment adjustment impact on Part B drugs. The Budget Act modified MACRA to exclude Medicare Part B drug costs from MIPS payment adjustments and from the low-volume threshold determination of MIPS eligibility. As a result, Medicare reimbursement for physician-administered drugs will not reflect the physician’s or group’s MIPS payment adjustment, and MIPS eligibility determinations, which are based on volume of Medicare services, will not include Medicare reimbursement for the cost and administration of these drugs. 
2. More gradual increase of threshold for avoiding a MIPS payment penalty. Under original MACRA policy, CMS would have been required to establish the performance threshold for avoiding a penalty under MIPS at the mean or median performance of all participants beginning in 2019. MACRA includes a special rule for 2017 and 2018 giving CMS the authority to establish a different threshold for success. CMS did so, setting a threshold of three points for 2017 and 15 points for 2018. In the Budget Act, Congress extended the flexibility for CMS to establish a threshold other than the mean or median for an additional three years as physician practices adapt to the new value-based payment program and CMS reduces administrative burden and provides feedback.
3. Slower transition to counting cost measures in MIPS total score. During reporting years 2017 and 2018, MACRA allows CMS flexibility in weighting the performance categories. CMS used this authority to weight cost at zero for 2017 and 10% for 2018. Beginning in 2019, CMS would have been required to count cost at 30% of the total MIPS score. Meanwhile, CMS is relying on flawed, holdover measures from the Value-based Payment Modifier that penalized practices with high-risk or medically complex patients and left many practices with no attributed costs while the agency continues to develop and test new cost measures. The Budget Act extended CMS’ flexibility to count cost measures between 10% and 30% of the total MIPS score for an additional three years, providing more time to develop and test new cost measures before they significantly affect a physician’s or group’s total MIPS score. The legislation also eliminated year-over-year improvement scoring for the cost category during reporting years 2018-2021 as differences in performance may be attributable to emerging and improving measure methodologies rather than real changes in the cost of care.

Ongoing regulatory relief efforts

MGMA continues its work with the American Medical Association and key specialty organizations as part of a small MACRA workgroup of associations. The goal is to reduce the administrative burden of the MIPS program and improve clinical relevance of Medicare quality reporting.

One of the outcomes of this coalition is a joint letter, spearheaded by MGMA, to CMS calling for a 90-day reporting period in 2018 due to the lack of timely notification of whether a physician is eligible for MIPS. In addition, it calls for a reduced reporting period in future MIPS program years to reduce the administrative burden of MIPS and ensure medical group practices have sufficient time to report after receiving performance feedback from CMS.