Press Release

WASHINGTON, DC – Representatives Ami Bera, M.D. (D-CA), Larry Bucshon, M.D. (R-IN), Kim Schrier (D-WA), Mariannette Miller-Meeks, M.D. (R-IA), Earl Blumenauer (D-OR), and Brad Schneider (D-IL) today led over 90 Members of Congress in a bipartisan letter to Speaker McCarthy and Leader Jeffries emphasizing the urgent need to establish a stable Medicare payment system that appropriately pays for health outcomes and ensures that we keep our communities healthy.

In the letter, the Members wrote:

“Financial uncertainty in our nation’s health care system has been growing for years, and further escalated during the COVID-19 pandemic. Despite spending significantly more on health care than other industrialized countries, the United States continues to face poorer health outcomes and is experiencing acritical shortage of health care providers. A contributing factor is our Medicare payment system, which has failed to maintain levels of provider reimbursement that adequately incentivize high-quality care.

In order to keep our patients safe, access to care available, and the healthcare workforce strong, Members of Congress must urgently work together to enact MACRA reforms, establishing a stable payment mechanism that appropriately pays for health outcomes. Please work with us to find a solution that ensures we keep our communities healthy.”

Click here to view the full letter.

In 2015, the bipartisan Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law. It replaced the sustainable growth rate (SGR) formula with the Quality Payment Program, consisting of a new Merit-Based Incentive Payment System (MIPS) and processes to adopt Advanced Alternative Payment Models (APMs). MACRA shifted Medicare’s approach to physician payment: paying providers based on quality, value, and the results of care delivered rather than the number of services provided.

Unfortunately, logistical challenges have plagued MACRA almost since its inception. Incentive payments to encourage Medicare providers to participate in Advanced APMs are set to expire at the end of 2023. Furthermore, the thresholds to qualify for APM incentives and future payment adjustments are also scheduled for steep increases under current law. Together, these factors could result in fewer providers participating in value-based care models in the years to come.

Payments made to physicians who participate in value-based care models are affected by the Physician Fee Schedule (PFS) released by the Centers for Medicare and Medicaid Services (CMS) each year. Revisions of this fee schedule have caused certain providers to face significant decreases in their reimbursement. Furthermore, though physician practice costs rise with inflation, the fee schedule is not adjusted accordingly. These factors are adding to physicians’ financial instability and encouraging consolidation of providers.

Last September, Reps. Bera and Bucshon led a group of bipartisan members in seeking feedback from health care providers, advocacy organizations, health economists, health finance experts, and others on actions Congress should take to stabilize the Medicare payment system. The Members received over 130 responses from stakeholders on the current state of MACRA and associated payment mechanisms.