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Experts Predict Trump Officials Will Change Doctor Pay Rules

By Kerry Young, CQ Roll Call

December 13, 2016 -- Physicians' groups likely will succeed in pressuring the Trump administration to ease requirements and administrative demands that the recent Medicare payment overhaul created, former top federal health officials said.

Medicare is in the midst of carrying out last year's law (PL 114-10) that's meant to peg physicians' pay more closely to judgments about the quality of care they provide. Medical groups already gained concessions when Centers for Medicare and Medicaid Services (CMS) allowed some medical practices to delay implementation and exempted smaller practices from reporting requirements. Doctors will press for more, even though the overhaul law has strong bipartisan backing, said former leaders of CMS Tuesday at the American Bar Association's Washington health law summit.

Doctors already frequently complain about time lost from patient care to enter data about treatments or tests their practices have provided. Last year's Medicare Access and CHIP Reauthorization Act relies heavily on such recordkeeping to help CMS officials make judgments about care. Jonathan D. Blum, a former principal deputy administrator at the Centers for Medicare and Medicaid Services in the Obama administration, said there will be "tremendous pressure" for delays and changes in MACRA rules. Leslie V. Norwalk, an acting CMS administrator for President George W. Bush, noted that Trump tapped a critic of the agency's implementation of the law as his nominee to lead the Department of Health and Human Services, Rep. Tom Price, R-Ga.

"Price has already complained about MACRA," Norwalk said.

Lawmakers may be reluctant to revisit the details of the 2015 law, leaving it to CMS to find ways to change the rules as much as allowed within the statute, she said. "There will be a big push to use that flexibility," Norwalk said.

Blum, Norwalk and Thomas A. Scully, who was a CMS administrator under President George W. Bush, also said they expect Medicare to continue to experiment with alternative forms of payments despite the current GOP ire with CMS' Innovation Center, which was created to experiment with payments or care through demonstration projects.

Many Republicans, including Price, complain about the center's experiments that compel participation of certain doctors and hospitals. CMS appears for now to have put on hold the center's most controversial proposal, a nearly nationwide test of an alternative form of payment for drugs administered in doctors' offices. Known as the Part B drug model, this proposed test would have covered payments for many cancer treatments.

The 2010 health law (PL 111-148, PL 111-152) gave the CMS Innovation Center an initial $10 billion in funding. Scully said Republicans may change their view of the center once they take change of CMS again and gain a better appreciation of how "powerful" it is as a tool for changing policy. They could look at it as a path for attempting to implement a House GOP goal of increasing insurers' role in administering Medicare, known as premium support, Scully said.

CMS may rebrand its program for testing forms of payments, but likely will continue to move away from the fee-for-service program, Norwalk said. Medicare's payment rules now often give doctors more money for doing additional procedures, which can waste government funds while posing some risk to patients, according to Norwalk. CMS officials will want to continue efforts to revamp payments to change these incentives, she said. CMS' Innovation Center in recent years has looked at bundled payments and systems that are intended to reward or punish hospitals and doctors based on the results delivered for patients.

"So I do imagine that we'll have these programs, in some way, shape or form, continue," she said.

Republicans in Congress and President-elect Donald Trump have set a repeal of the 2010 health law as a top priority for next year. Some Republicans are seeking to have that repeal take effect slowly, so that they can create an alternative. They appear likely to prevail, according to Scully's view. 

"Nothing in the law is going to change for two years, most likely," Scully said.

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