Press Release

#SubHealth Reviews Alternative Payment Models Under MACRA Implementation


WASHINGTON, DC – The Health Subcommittee, chaired by Rep. Michael C. Burgess, M.D. (R-TX), today held a hearing to get a check-up on Alternative Payment Models (APMs), including those that are qualified under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.

Hearing from those on the front lines engaged in the transition to value based care, #SubHealth received an update from officials developing new models and stakeholders who are already delivering improved outcomes and savings for Medicare beneficiaries and taxpayers.

Ms. Mitchell provides an opening statement.

Kicking off the first panel was Dr. Jeffrey Bailet, Chairperson, Physician-Focused Payment Model Technical Advisory Committee (PTAC) and Ms. Elizabeth Mitchell, Vice Chairperson, PTAC.

Written testimony by both Dr. Bailet and Ms. Mitchell states, “…PTAC has held 9 days of public meetings, deliberated on six proposals, voted on five with submitted reports to the Secretary and has 14 proposals under active review. This level of interest and activity reflects a readiness and demand for change from leaders across the physician community and beyond, including a willingness to participate in alternative payment models and to accept some form of risk, either two-sided risk for total cost of care, variants of capitation, and risk for achieving quality outcomes.” …It is our belief that the interest in and work of PTAC affirms Congress’ direction and intent for MACRA to transition US health care to a high-value system delivering better care at lower cost.”

The hearing’s second panel focused on stakeholders who are already using some of these new models.

The second panel shared their expertise on these new models.

Dr. Frank Opelka, Medical Director, Quality and Health Policy, American College of Surgeons (ACS), shared the story behind their journey to develop an APM, saying, “Overall, our experience in navigating the pathway for physician-focused payment models created by MACRA has been a time consuming and complex yet rewarding experience. We have taken the long view in development of our model, shooting for a model that will ultimately serve the needs of our patients and provide meaningful APM participation options for the broadest range of our members and other providers.

Dr. Bill Wulf, CEO, Central Ohio Primary Care Physicians (CAPG), highlighted a recent study in the American Journal of Managed Care, which “compared two physician organizations in Medicare Advantage, one where the MA plan paid its downstream physicians with fee-for-service (FFS), the second where the MA plan paid its downstream physician organization a capitated payment. The capitated group had higher quality and generated cost savings. Specifically, the patients in the capitated (advanced APM) group had a six percent better survival rate and a 32.8 percent lower risk of dying as compared to the FFS group.”

Dr. Daniel Varga, Chief Clinical Officer, Texas Health Resources, Premier, Inc., spoke to positive effects of their Next Generation Accountable Care Organization (ACO), saying, “…because of our participation in a Next Generation ACO, we have waivers from some of the constraining Medicare requirements. This enables us to work with our clinicians to innovate the care delivery process. We are also able to reduce the CMS reporting burden for our clinicians by reporting those measures for them as a group.”

“It has been two and a half years since MACRA became law,” said #SubHealth Chairman Burgess. “I believe the true potential of MACRA has yet to be met, but I believe the law has already been proven a success in delivering better care to beneficiaries, savings to the Medicare program, and certainty to doctors. …Finally, it is critical that what we accomplish today follows the same open, transparent, and bipartisan structure that helped get MACRA signed into law.”

For more information on today’s hearing, including a background memo, witness testimony, and archived webcast, click here.



Health (115th Congress)
Press Release