American College of Rheumatology Issues Recommendations for Fixing MACRA and Improving Provider Participation in Value-Based Care Models
November 1, 2022 | Advocacy
Washington, DC. – Responding to U.S. Reps. Ami Bera, MD (CA-07), and Larry Bucshon, MD (IN-08)’s, request for information on the Medicare Access and CHIP Reauthorization Act (MACRA) program, the American College of Rheumatology (ACR) today offered recommendations to improve the landmark law enacted seven years ago that changed how Medicare reimburses for physician services. The letter also describes recommendations to improve provider participation in Medicare’s Merit-Based Incentive Payment System and other alternative payment models.
“Medicare’s Quality Payment Program was a reasonable first step, but QPP 2.0 must revive incentive payments the law originally intended,” said Kenneth G. Saag, MD, MSc, President, American College of Rheumatology. “Today’s Quality Payment Program is built on avoiding penalties and can be improved to better incentivize high-quality care. By addressing regulatory, statutory, and implementation challenges, program participation will become more attractive to more practices and truly live up to the promise of driving more value for patients and providers.”
In particular, the ACR noted that Congress must ensure that reimbursements for Evaluation and Management (E/M) Services, which account for face-to-face care time with a patient, are re-evaluated on a regular basis. Cognitive specialists like rheumatologists provide face-to-face care for individuals with complex medical conditions. But Medicare underprices E/M office visits relative to other services, such as procedures, creating an imbalance that contributes to significantly unequal reimbursement levels for physicians in procedural specialties relative to those who rely more extensively on E/M type visits.
Re-evaluating the codes regularly, the ACR says, will more accurately account for the fundamental underpinnings of providing primary and complex chronic care and improve patient care, especially for individuals with chronic conditions.
View the ACR's list of recommendations contained in the full letter.
About the American College of Rheumatology
Founded in 1934, the American College of Rheumatology (ACR) is a not-for-profit, professional association committed to advancing the specialty of rheumatology that serves nearly 8,500 physicians, health professionals, and scientists worldwide. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatology professionals are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases.