Representatives Bera and Buschon, along with their colleagues requested feedback from stakeholders on actions Congress should take to stabilize the Medicare payment system while ensuring successful value-based care incentives are in place. Specifically, the RFI asked that responses should address the effectiveness of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA); regulatory, statutory, and implementation barriers that need to be addressed for MACRA to fulfill its purpose of increasing value in the US health care system; how to increase provider participation in value-based payment models; and provide recommendations to improve the Merit –Based Incentive Payment System (MIPS) and Alternative Payment Models programs. The AUA submitted a letter in response on October 31^st, 2022.

The AUA states that Medicare physician payment, which has stagnated, cannot be stabilized without eliminating the budget neutrality requirement and implementing an inflationary adjustment like those included in other Medicare payment systems. Additionally, data utilized in determining cost components such as the Medicare Economic Index (MEI) or practice expense inputs are outdated; utilizing current data to update the MEI is critical to ensuring fair updates to physician payment.

The AUA urges Congress to revise the Quality Payment Program (QPP), which includes MIPS and APM, to support the delivery of value-based care and improved quality without creating administrative burden. CMS needs authority and resources to create programs that are meaningful to all providers and specialty types, while lowering the burden to participate in these programs. Therefore, it is important that CMS or other agencies are authorized to underwrite measures that are used in these programs.