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Putting Patients in the Driver's Seat

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Yesterday, the Subcommittee on Health, chaired by Rep. Peter Roskam (R-IL) held a hearing on "The Implementation of MACRA's Physician Payment Policies." MACRA is the Medicare Access and CHIP Reauthorization Act of 2015.

This hearing was a chance for Members to discuss with witnesses from the Centers for Medicare and Medicaid Services (CMS) about the implementation of MACRA and better understand its role in creating more valuable, patient-centered care for seniors and other beneficiaries.

As Chairman Roskam said at the start of the hearing:

"Our role as Congress is to provide oversight, and in conjunction with CMS, continue to provide education on how our law is working for providers in Medicare. … We hope to continue to hear from stakeholders and work with CMS in implementing this law correctly, and ensure that we achieve the goal that I believe we all share, that MACRA work as intended."

Demetrios Kouzoukas, Principal Deputy Administrator for CMS, highlighted to the Subcommittee four key areas that Health and Human Services Secretary Alex Azar has prioritized to improve our nation's health care systems -- emphasizing that these are shared goals for CMS for implementing MACRA:

"First, give consumers greater control over their health information through interoperable and accessible health care information technology… Allow them to get their information in their hands so they can move around and be consumers in a health care market.

"Second, encourage transparency for patients and providers so that patients can make choices based on pricing and quality as they would in any other market.

"Third, leverage the power of patients and put resources behind them by using the authorities at [the Center for Medicare and Medicaid Innovation]…to help drive value and quality through the entire system.

"Last, reduce government burdens that impede this transformation by ensuring that patients can spend more time talking to their physicians and facing them in one-on-one conversations rather than looking at the back of their lab coat. These are the same principles that guide our implementation of Congress' vision for Medicare clinician payment through MACRA."

Throughout the hearing, Members discussed challenges that they have heard about from medical providers in their districts regarding MACRA implementation and asked what actions are currently being pursued by CMS to improve this important program.

Rep. Kenny Marchant (R-TX) expressed concerns regarding "Stark Law" -- a set of federal prohibitions placed upon physicians regarding Medicare or Medicaid patients -- and how a lack of modernization of these laws would restrict the success of MACRA.

Rep. Marchant asked what CMS is doing to alleviate the burdens physicians face due to Stark Law. Mr. Kouzoukas responded:

"Stark…has a really big impact on how relationships are structured in the health care space. Our focus on it is essentially recognition that we're talking about value-based care and ensuring that value-based health care has that patient driven focus, and that we're talking about not creating a health care system that's centered in Washington but assembled by each patient."

Rep. Erik Paulsen (R-MN) asked what CMS is considering in terms of opening up opportunities for stakeholders across all medical sectors to innovate and collaborate in value-based arrangements, both within and outside of MACRA. Mr. Kouzoukas said:

"We're really excited about the dynamic that you're bringing to the table here on competition and bringing in new players. We strongly believe that the system is going to work best if there's an array of choices. Those choices may well come from the existing structures, but I think the Secretary has laid out in his speeches a willingness to be disruptive and a willingness to change the rules of the game in a way that's going to invite new forces in to the health care system. … We need to be open to new players, we need to be open to innovative solutions."

Rep. Diane Black (R-TN) stressed how important it is that there be a focus on rural communities as Congress and CMS work to create a more patient-centered health care system:

"With over 50% of my district in middle Tennessee being rural…these small, rural, and independent practices and physician-led groups are well positioned to lead the transition to value-based care and succeed in new payment models."

Chairman Roskam closed the hearing by asking what CMS wants lawmakers to be focused on as they continue their work to improve Medicare. Mr. Kouzoukas stressed:

"Value-based care means patients are in the driver's seat. …if we do that, we will ensure value-based health care isn't something that is created in Washington but an opportunity for each patient to decide for themselves and assemble for themselves health care."


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