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Committee Spotlight: What's Coming? Changes to ACA but MACRA Stays

While Dr. Michael Dalsing doesn’t have a crystal ball, he is nonetheless making two predictions in the wake of the November presidential election:

1.    Changes will come to the Affordable Care Act.
2.    MACRA, MIPS and APMs, part of the replacement legislation for Medicare reimbursement, will remain and SVS members will need to learn about it. 

“There are misperceptions as to the effect of the new government,” said Dr. Dalsing. He chairs the SVS Government Relations Committee, which oversees government relations activities and works on all federal legislative and regulatory issues affecting vascular surgery. 

On the one hand, members are confronting MACRA – the Medicare Access and CHIP Reauthorization Act – which has been in development since Congress repealed the Sustainable Growth Rate in 2015. 

Then there’s the election, whose winner, President-Elect Donald Trump, vowed to repeal and replace the ACA. It’s easy to see members might be reconsidering what this all means for their futures.

“I don’t think there’s any question that the ACA will be revamped,” Dr. Dalsing said. “How, I don’t know, but it’s going to happen, especially in terms of how it will be funded and its rules going forward.”

However, MACRA will not go away, he predicted. “The SGR had to be replaced; it was going to run off the rails. This replacement program was a bipartisan proposal,” he said. “But people think somehow it’s all going to change. And I don’t think it is. It’s NOT Obamacare. They’re two different things, and our members need to know about MACRA and get ready.”

Committee members and staff have worked from the beginning to shape and impact the highly complex MACRA to benefit vascular surgery and SVS members. The committee worked closely with members of Congress and submitted comments to the Centers for Medicare and Medicaid Services on the Proposed and Final MACRA rules, plus the Medicare 2017 Physician Fee Schedule Final Rule. 

“They actually listened to us quite well,” Dr. Dalsing said, and a number of changes SVS had sought have been implemented. “We now have some options.” 

A number of changes in the Fee Schedule are outlined in Washington Update. Other MACRA improvements that SVS sought and received in what Dr. Dalsing called “a big win,” include:
•    Changing the requirements of how to demonstrate quality outcomes, providing multiple options in the “Pick your Pace” program. 
•    Delaying the start date of penalties for non-involvement with such quality measures. 

The committee also is looking into an Alternative Payments Model (APM) for vascular surgeons as no such payment model currently exists. An ad hoc committee has been established and members will work with other societies as well. “It’s a big proposal and initiative,” Dr. Dalsing said. “It may well take 12 to 18 months to accomplish the entire project.” 

In terms of other changes that might accompany the advent of the Donald Trump administration, Dalsing said, “There are a lot of questions. It depends on who gets nominated in key positions. We simply are at the start of the process.”

Whatever happens, the committee is ready to respond. “The Government Relations Committee provides comments and suggestions to improve legislative programs,” he said, adding, “and there are always legislative issues to consider which affect the lives of our members in one way or another.”