The House Energy and Commerce Subcommittee on Oversight and Investigations held a hearing this week to examine the implementation and challenges that exist for patients and doctors under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

This is the first hearing in the House of Representatives since implementation of the law, which was intended to drive U.S. care delivery and payment reform from volume to value and introduced through the creation of the Merit-Based Incentive Payment System and Advanced Alternative Payment Models (APMs).

The Hearing featured testimony from a panel consisting of several experts representing health policy research institutions, academic groups, and the National Association of ACOs on questions related to development of provider-driven models and APMs; challenges faced by small providers, including costs and bureaucracy within MACRA; effects of MACRA on consolidation and patient access; and how policymakers can strengthen oversight of the law through data and meaningful measures to provide better quality care to patients.

Rep. Mariannette Miller-Meeks, MD, (R-IA) asked a question submitted by the ACC regarding the impacts of continued consolidation and integration of private practices into hospitals and health systems, as well as private equity mergers, on clinicians’ ability to stay in practice and participate in new and innovative APMs. The panelists noted that consolidation is a problem that has consequences, including limiting options, increasing costs and worsening the quality of health care delivery. They noted no reason why APMs should not encourage smaller organizations to participate and allow them to thrive, while also suggesting that the Centers for Medicare and Medicaid Services could be well served by streamlining options to have fewer, well-designed models that facilitate participation from practices of all sizes.

Clinical Topics: Cardiovascular Care Team

Keywords: Commerce, Private Practice, Health Policy, Medicaid, Medicare, ACC Advocacy

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