By skyforbes 
Earlier this year, Tincture spoke with Acting Administrator at Centers for Medicare and Medicaid Services (CMS), Andy Slavitt. Below is the first transcribed portion of the conversation between Andy and Dr. Jordan Shlain, Tincture’s founder and editor-in-chief. It has been edited for clarity. (This is the second part of a series; see here for the first part and the third part.)
Jordan Shlain: Andy, you’ve spoken before about winning back the hearts and minds of physicians. I’m wondering — how did we lose the hearts and minds of physicians in the first place? Can MACRA really solve that?
Andy Slavitt: I think you’d probably draw a couple of conclusions. One is, we’ve generated too much paperwork, too much time away from patient care. When we set up a big program like this- it’s very easy to agree that quality should be improved. Very few people would argue with the idea that physicians should be recognized for delivering more quality and value.
The problem is when those ideas get implemented, almost by their very definition they get implemented in a series of pieces over time…and they have the effect of stacking upon one another. So you have different regulations and laws that are passed in various years, and then they add on top of one another. It’s a situation where good things on top of good things can become bad things. Looking at the end result, it’s arguable that the individual pieces were even good things to begin with.
And then if they get implemented for a physician who has more than one health plan paying them, they get implemented differently. Then, all of a sudden it’s not just adding up badly, it’s adding up badly geometrically.
The second point is that the paperwork doesn’t feel relevant to improving patient care. Paperwork is one thing — we all have to deal with it to some degree, and we certainly want to minimize it — but the paperwork needs to feel relevant. Giving physicians information in a registry that helps them understand how they can improve care is one example. Giving them better information about their patients, or their practice — that feels like it’s got some value. I think we’re at a place today where by and large that’s not always the case.
Jordan: Yeah.
Andy: So, that’s how we got to where we are. The only thing I’ll add is that this creates an imperative for us to use MACRA as a platform to take this patchwork of programs that have been put in place, and streamline them into one program that can be simplified and rationalized over time. But even immediately, we can go out of the gate and find redundancies and duplications and eliminate them. We are looking for the things that physicians report on that we don’t need them to report on, because we can get the information some other way. Or, because many physicians are already doing quite well. Something might matter to us, but if we know the physician is doing well, why make them report on it?
Challenging ourselves to think and act on these issues has been what implementing the quality payment program has been all about.
Jordan: You’ve just mentioned it, but let’s talk in more detail about the timeframe for the MACRA rollout. When do you think we’ll see the fruits of this labor? It’s a multi-year process, but how long will it take to start to show some benefits for physicians and patients?
Andy: The law is designed to ramp up. There’s some acknowledgement that there’s going to be a first year to the program, and like the first year of any program we’re going to see people behaving very close to how they’re behaving today. If anything there are lower burdens to measurement and reporting under both components of the Quality Payment Program, which is what we are rolling out to implement MACRA — there are lower burdens than those that exist today. Those will scale and grow over time.
Looking down the line, what the law envisions and what physicians would hope for — are that payment models are more and more relevant to the way they’re practicing, more relevant to the specific needs of their specialty, or their state, or their population. There are things that are gaining traction today — medical homes, bundled payments, accountable care organizations, but which are very, very early.
I described them earlier as being first and second generation models. Generation One was generated in a lab, and Generation Two was generated almost based entirely upon what was learned from the first Generation. So some of the things that physicians and patients have told us they value and they want to keep — like aligning the same incentives for consumers and the physicians, using telemedicine — those are in the new models.
I think we ought to be somewhat modest about what we’ve accomplished so far. In a few years, I suspect a couple of things will have changed. First, we’ll be on Generation Six and Seven — which will be simpler, more sophisticated, easier to use, and working in the background. Second, there will be a lot more model options. So any specialty under MACRA should be able to design and propose a model that we would then put into practice and implement.
I envision the day where different specialties and subspecialties will say, “These are the measures that matter to us — can you put a program into place?” And I think that will help tremendously– there will be a lot of choice flexibility in the models, and in the components of the models.
What outcomes will we see? With many of the things we’ve talked about — reducing readmission rates for example — there’s been a lot of progress over the last five years. I think we will see very specific outcome areas, where physicians feel like there’s the most room to move the needle, and where patients most value, where we’ll see very significant improvement. And finally, and this is very, very important to me is the general, overall satisfaction with the health care experience from both the patient and the physician. Satisfaction rates need to start moving up and I think they will.