Participating May 20 at an Alliance for Health Reform briefing on the Medicare Access and CHIP Reauthorization Act, Ashley Thompson, AHA senior vice president for public policy analysis and development, shared AHA’s views on the law and recent proposed rule implementing key provisions of its new physician payment system.

She noted that hospitals have a stake in the legislation because they directly employ or contract some 540,000 physicians, and “physicians and hospitals must partner together to move toward value-based care.”

While welcoming the proposed rule’s efforts to streamline physician reporting burden, she said hospital-based physicians should be able to use their hospitals’ quality reporting and pay-for-performance program to measure performance in the Merit-based Incentive Payment System.

Ashley ThompsonShe said the program also should employ risk adjustment rigorously to ensure providers do not perform poorly simply because they care for more complex patients, and include investment risk as it looks to define advanced alternative payment models. As the Centers for Medicare & Medicaid Services proposes to provide more flexibility in reporting on use of electronic health records by physicians, the agency should also extend flexibility to hospitals to keep alignment across settings, according to Thompson.

CMS is trying to ease the burdens of small practices as they transition to the new physician payment system, said Kate Goodrich, director of CMS’ Center for Clinical Standards and Quality. She said the agency soon will put out a request for proposals for a $100 million pool of funds for technical assistance for small and rural practices and those in areas with shortages of doctors.

Timothy Ferris, senior vice president for population health management at Partners HealthCare, noted that MACRA is ”asking physicians to make investments in infrastructure and change behaviors two years before they know whether they are getting a reward or punishment.”

Under the proposed rule, the first MIPS performance period would start on Jan. 1, 2017, running the full calendar year, with the first MIPS payment year scheduled to begin in 2019.

MACRA could be more significant than the Affordable Care Act, because it seeks to alter the “fundamentals of delivery payment,” said Elizabeth Mitchell, CEO of the Network for Regional Healthcare Improvement.