Dear Leader McConnell, Leader Schumer, Speaker Pelosi and Leader McCarthy:
Since the enactment of the Medicare Access and CHIP Reauthorization Act (MACRA), the undersigned
organizations have worked closely with both Congress and the Centers for Medicare and Medicaid
Services (CMS) to promote a smooth implementation of the Merit-Based Incentive Payment System
(MIPS) and Alternative Payment Models (APMs). While MACRA represents an improvement over the
flawed sustainable growth rate payment methodology and legacy quality and cost reporting programs, its
implementation has been a significant undertaking for CMS and physicians. We strongly supported the
improvements to MACRA included in the Bipartisan Budget Act of 2018, which allowed for a more
gradual transition into the program and helped many physician practices avoid penalties they likely would
have otherwise incurred under the MIPS program. However, further refinements are needed to improve
the program and ensure physicians can be successful going forward.
In order to foster the continued success of MACRA, we urge Congress to implement positive payment
adjustments for physicians to replace the payment freeze over the next six years, extend the Advanced
APM bonus payments for an additional six years, and implement several additional technical
improvements to MACRA, which are outlined below.
Implement Annual Positive Payment Updates
MACRA included modest positive payment updates in the Medicare Physician Fee Schedule, but it left a
six-year gap from 2020 through 2025 during which there are no updates at all. Following this six-year
freeze, the law specifies physician payment updates of 0.75 and 0.25 percent for physicians participating
in APMs or MIPS, respectively. By contrast, other Medicare providers will continue to receive regular,
more stable updates. As physician practice payments fall increasingly below their costs, patient access
issues would arise.
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