AAFP: MACRA-Ready Set Go New Mexico Academy of Family Physicians Annual Meeting July 27-30, 2017 Robert L Wergin MD, Past President AAFP.

AAFP: MACRA-Ready Set Go New Mexico Academy of Family Physicians Annual Meeting July 27-30, 2017 Robert L Wergin MD, Past President AAFP

Pay Now … Or Pay Later

Healthcare Expenditures vs. Outcomes
Healthcare Expenditures as % of GDP, 2005* Average life expectancy, 2007 30% of MHS beneficiaries are obese and 40% are overweight. Obese beneficiaries cost the MHS $1,429 more than persons of normal weight. 60% of premature deaths are attributed to social, environmental and behavioral factors; 10% are due to healthcare factors^ Social service expenditures are associated with better outcome measures for: Life expectancy Infant Mortality Potential years of life *Bradley EH, Elkins BR, Herrin J, et al. Health and Social Services Expenditures: Associations with Health Outcomes. BMJ Qual Saf (2011).** Robert Wood Johnson Commission to Build Healthier Communities 2009: JM, Russo PG, Knickman JR. The case for more active policy attention to health promotion. Health Aff (Millwood) 2002;21(2):78–93 *Bradley EH, et al. Health and Social Services Expenditures: Associations with Health Outcomes. BMJ Qual Saf (2011). *McGinnis JM, Russo PG, Knickman JR. The case for more active policy attention to health promotion. Health Aff (Millwood) 2002;21(2):78–93

U.S. HEALTHCARE WASTE = NETHERLANDS GDP
$210bn Unnecessary Services $190bn Administrative Costs $130bn Inefficient Delivery of Care $55bn Prevention Failures $105bn Inflated Prices $75bn Fraud $765bn in wasted spending Source: Institute of Medicine (2009 data); The World Bank (2009 data)

THE FUTURE HEALTH ECOSYSTEM WILL FOCUS ON THE TRUE DRIVERS OF OUTCOMES
GENETICS DIET & EXERCISE TOBACCO USE ALCOHOL & DRUG USE SEXUAL SLEEP ACTIVITY ACCESS TO CARE QUALITY OF CARE AIR WATER QUALITY HOUSING TRANSIT QUALITY EDUCATION EMPLOYMENT INCOME SOCIAL SUPPORT COMMUNITY SAFETY Source: RWJF/UWPHI.

Sustainable Growth Rate 2002-2015
But, before we move on to MACRA, let’s take a moment to remember the SGR. The SGR was in place for 18 years and it cost the country roughly $169 billion dollars in “fixes” to avoid cuts to physician payments. In fact, if not repealed in 2015, the SGR was set to cut Medicare physician payments 21%. So, regardless of how complicated the new MACRA law seems, we know it is better than the SGR which only offered payment cuts with no opportunity for payment increases or bonuses.

MACRA: Medicare’s Shift to Value-based Delivery & Payment Models
Current as of 11/1/2016

Current State Volume over Value Fee for Service
Over Utilization Volume over Value Silos of Care This is the current fee for service state we are all familiar with… because we live in it every day. It is not set up to reward value or quality and, in many cases;… it promotes over utilization and fragmented care. Fee for Service

Push Toward Value & Quality
Medicare payments tied to quality or value by end of 2016 Of those through alternative payment models (APMs) by end of 2016 Private payer business through value-based arrangements by 2020 In January 2015, the Secretary of the Department of Health and Human Services announced payment goals that will work to change the current state. The first goal is to tie 85% of Medicare fee-for-service payments to quality or value by the end of 2016, with 90% of payments tied to quality or value by the end of 2018. The second goal is to have 30% of those quality and value payments made through alternative payment models by the end of 2016. On March 3rd two thousand sixteen, President Obama announced Medicare had already met the 30% goal, almost a full year ahead of schedule. Private payers have gotten on board as well. Soon after the Secretary made her announcement, private payers committed to having 75% of their business tied to value-based arrangements by 2020. This reinforced the commitment of the entire healthcare delivery system to payment reform that emphasizes …value…over… volume. 75%

The Medicare Access and CHIP reauthorization Act (MACRA) is the key legislative piece that moves the healthcare system closer to meeting the goals laid out by the Secretary. The first line in the legislation is spelled out here, and it states clearly what the law is intended to do…To repeal the Medicare Sustainable Growth Rate (the SGR) and strengthen Medicare access by improving physician payments If only the law were this simple!

Materials herein reflect public law 114-10 dated April 16, 2015
MACRA Timeline MACRA enacted: April 16, 2015 Passed 392 to 37 in the House and 92 to 8 in the Senate Request For Information: October 2015 Proposed Rule released: April 27, 2016 60-day comment period Final Rule released: October 14, 2016 *Medicare physician fee schedule published separately Comment reviews – watch for additional deadlines Materials herein reflect public law dated April 16, 2015

MACRA Legislative Timeline
MACRA enacted Request for Information Proposed Rule released Final Rule w/ comment April 16, 2015 October 1, 2015 April 27, 2016 October 14, 2016 This is what the legislative timeline looks like. The MACRA law was passed in April 2015, in October 2015 CMS asked any and all interested stakeholders to submit answers to roughly 220 questions to determine how to make the law actionable. The AAFP submitted a lengthy response to this request for information. CMS took our response and the responses from all of the stakeholders and created the proposed rule. A 962 page draft was CMS’s first attempt to define the rules of what will be the Quality Payment Program going forward. The AAFP has reviewed the full document page by page and submitted over 100 pages of comments and suggestions to CMS. The final rule was released on October 14th. It includes a comment period in which AAFP will reply in order to help inform their decisions for the coming rules. *Medicare physician fee schedule published separately

What Does MACRA Do? Repeals the Sustainable Growth Rate (SGR)
Extends Children’s Health Insurance Program (CHIP) funding for 2 years Creates 2 payment pathways Provides Annual Baseline Fee Schedule Updates But, before we move on to MACRA, let’s take a moment to remember the SGR. The SGR was in place for 18 years and it cost the country roughly $169 billion dollars in “fixes” to avoid cuts to physician payments. In fact, if not repealed in 2015, the SGR was set to cut Medicare physician payments 21%. So, regardless of how complicated the new MACRA law seems, we know it is better than the SGR which only offered payment cuts with no opportunity for payment increases or bonuses.

“The difference between what’s made available to me as a surgeon and what’s made available to our internists or pediatricians (or family physicians) or HIV specialists is not just shortsighted – it’s immoral” Atul Gawande The Heroism of Incremental Care Annals of Medicine, January 23, 2017

In 2019 Physicians Must Choose One of Two Paths Forward

A More Accurate Scenario

How Some Members Will See It

Streetlight Effect = Observational Bias
A policeman sees a drunk man searching under a streetlight and asks what he has lost. The drunk says he lost his keys, and they both look under the streetlight together.

Streetlight Effect = Observational Bias
After a few minutes, the policeman asks, “Are you sure you lost them here?” The man replies, “No, I lost them in the park.” The policeman asks, “why are you searching here?” The drunk replies, "this is where the light is.”

Current “Quality” Metrics
Are too numerous Are often inappropriately applied at the level of individual clinicians Lack evidence that they correlate with better health Compromise the patient-physician relationship Motivate diversion of resources and efforts away from more meaningful interventions Do not typically address harms associated with overtreatment Were often developed by prioritizing expediency

What Does MACRA Do? Merit-Based Incentive Payment System (MIPS)
Consolidates quality programs Advanced Alternative Payment Models (AAPM) Potential for bonus payment for participation As we mentioned previously, MACRA introduces two new payment tracks: One that consolidates quality programs –the Merit Based Incentive Payment System (MIPS) And Alternative Payment Models (APMs) - which have the potential for bonus payments for participation We anticipate many of our members will move through MIPS into the alternative payment model track.

Here is a graphical representation of the MACRA path you will be venturing on.

Clinical Nurse Specialist Certified Registered Nurse Anesthetist
QPP Participants MACRA defines eligible clinicians as: Physicians (MD/DO) Physician Assistant Nurse Practitioner Clinical Nurse Specialist Certified Registered Nurse Anesthetist The final rule defines eligible clinicians physicians (MD/DO), Physician Assistants, Nurse Practicioners, Clinical Nurse Specialists and Certified Registered Nurse Anesthetist. Other providers will added *You are not required, as a condition of participating in the Medicare program, to participate in either of the QPP pathways. You may elect to provide care to Medicare patients and not participate in the QPP. However, if this is your decision, you will face maximum negative payment updates as established by the law.

Merit-Based Incentive Payment System
(MIPS) Lets take a look at MIPS in more detail

MIPS Highlights Consolidates existing quality and value programs
Adds a category for Improvement Activities Establishes a Final Score Weighted scoring by category Provides opportunity for payment adjustments Both positive and negative Highlights of MIPS include the consolidation of existing quality and value programs to reduce administrative burden; establishment of a performance score; and sliding scale payment adjustments.

Consolidates Quality & Value Programs
PQRS VBPM MU MIPS Physician Quality Reporting System Value Based Payment Modifier Meaningful Use After reading the law, but prior to the proposed rule being released, this is how we anticipated the current reporting programs would be merged together to create a single MIPS program.

“Consolidates” Old New Meaningful Use =
PQRS VBPM MU “Consolidates” Old New Meaningful Use = Advancing Care Information (ACI) Value-Based Payment Modifier Cost PQRS Quality Advancing Care Information What actually happened is the current programs went into the funnel and came out as three moderately changed programs with new names. Meaningful Use is now Advancing Care Information, Value-based Payment Modifier is now Resource Use, and PQRS is now Quality. The proposed rule has done little to consolidate or reduce the administrative burden associated with these programs as initially indicated. Cost Quality

What’s it called? MACRA – April 2015 Proposed Rule – April 2016
Final Rule– October 2016 MU Advancing Care Information Advancing Care Information Value Modifier PQRS Resource Use Quality Cost Quality CPIA IA Advancing Care Information CPIA

MIPS Final Score Quality Cost Advancing Care Information (ACI)
In addition to the more familiar programs that will be used to calculate a MIPS composite score, a new category of clinical practice improvement activities has been introduced. Physicians will be assessed, and receive payment adjustments, based on a composite score comprised of these four categories. You will see that many primary care providers are already doing something (if not a lot) in each of these categories. Quality – Physicians will need to report on 6 measures of their choosing- one being cross-cutting and one being an outcome measure. Those that have been reporting PQRS will be familiar with this process. Resource Use- Similar to value-based payment modifier, there will be no data submitted by physicians to CMS for this category. CMS will use claims data to calculate the score. Advancing Care Information- which is the old Meaningful Use, is reported very much the same as the previous program. Then, there is the new category of Clinical Practice Improvement Activities Quality Cost Advancing Care Information (ACI) Improvement Activities

Improvement Activities – New!
Expanded Practice Access Population Management Care Coordination Beneficiary Engagement Patient Safety and Practice Assessment Achieving Health Equity Emergency Response and Preparedness Integrated Behavioral and Mental Health New but not really! - While the Clinical Practice Improvement Activities category is new, the functions identified are not. These functions are the overarching categories for the roughly 90 activities named in the proposed rule as clinical practice improvement activities. Many of these activities you may have already done if you’ve worked toward PMCH recognition, either through an accrediting body, a payer, or a state based program.

Weighting by Category - 2017
This is a breakdown of year 1 scoring. The four categories above contribute points, in a weighted fashion, to make up the performance score. The total number of points scored will range from 0-100, with each category weighted as established in statue. Quality 60% Cost 0% IA 15 ACI 25 This is a breakdown of year 1 scoring. The four categories above contribute points, in a weighted fashion, to make up the MIPS Composite Performance Score. The total number of points scored will range from 0-100, with each category weighted as established in statue. You will notice there is a footnote for CPIA. Specifically, a “Certified” patient centered medical home will receive the full 15 points for this category. Those in alternative payment models who do not qualify for the alternative payment model bonus, will get half the credit for the CPIA category. We will discuss this more in the alternative payment model section. “Certified” patient centered medical home is defined in the proposed rule as those recognized by NCQA, the Joint Commission, URAC, and AAAHC. The AAFP is advocating for state-based and payer programs to be included in this definition as well.

Weighting Progression
2019 2020 2021 Quality 60% 50% 30% Cost 0% 10% Advancing Care Information 25% Improvement Activities 15%

‘Pick your Pace’ Options for 2017
Test Submit some data to QPP No negative adjustment Partial Participation Report minimum 90 days Small positive adjustment Full Participation Report 90 days up to full year Modest positive adjustment Advanced APM Qualifying Program & Qualified Participant 5% incentive payment Use Executive Summary Notes Here NO NEGATIVE PAYMENT ADJUSTMENTS

“Pick Your Pace” Reporting
Test Report one quality measure, one improvement activity, or all four of the required measures within the advancing care information (ACI) category Partial Participation Report a minimum of 90 days for more than one quality measure, more than one improvement activity, or more than four of the measures within the ACI category. Full Participation Report to MIPS for a full 90-day period or full year

Annual Performance Threshold
Established by Secretary years 1 and 2 For transition year 2017, threshold is 3 Below = negative payment adjustments Above = positive payment adjustments When MIPS begins in 2019, there is no historical “look back” period of previous MIPS scores to use to set a performance threshold. The law gives authority to the Secretary of Health & Human Services to establish the performance threshold in years one and two. After that, the performance threshold will be based on the mean or median of the previous year’s MIPS scores. MIPS scores will then be compared to the threshold. Scores above the threshold will yield positive payment adjustments and scores below the threshold negative adjustments.

*Adjustment to provider’s base rate of Medicare Part B payment
Adjust Payments -4% -5% -7% -9% 4% 5% 7% 9% onward *Potential for 3X adjustment Beyond the baseline adjustments, written into the law are higher adjustments for the highest performers. These can be up to 3 times the maximum adjustment for that year. But the positive and negative adjustments must still be budget neutral. Also, positive and negative adjustments will be made on a sliding scale, which is important. People will likely get a wide range of adjustments between 0 and the maximum for the year, not necessarily in whole numbers. We may be seeing adjustments carried out several decimal points. At this time, we don’t know. It is important to note, the adjustments are not cumulative, whether positive or negative. Every year, your baseline resets to zero. Outside the budget neutral adjustments, for years , there is $500M set aside for additional positive payment adjustments of up to 10% for “exceptional performers”. As the proposed rule is written, exceptional performers will be those that score in the top 25% of MIPS scores. Before leaving this slide, an important note for lower performers who score in the lowest quartile of MIPS scores: These providers will automatically be adjusted down to the maximum penalty for that year *Adjustment to provider’s base rate of Medicare Part B payment

Adjustment Summary Performance Score Payment Adjustment
Exceptional Performers (Final Score over 70) = Eligible for up to 10% positive adjustment in 2019 25th Percentile or below Maximum negative adjustment At threshold Stable Payment Here are some key points to remember: If you score in the lowest quartile of MIPS scores, you will automatically be adjusted down to the maximum payment adjustment for the performance year. If you score at threshold, you receive no adjustment Exceptional performers are eligible for a potential positive payment adjustment up to 10%. This incentive will be paid based on a sliding scale and is outside the budget neutrality. $500M has been set aside to cover this incentive payment. Exceptional has been proposed to be the top 25% of MIPS scores. And it is important to remember, this program is budget neutral, so the total negative adjustments must equal the total positive adjustments.

MIPS Exemptions Year 1 Medicare
Eligible Advanced Alternative Payment Model with Bonus Below low volume threshold Less than or equal to $30,000 Medicare payments; or less than or equal to 100 Medicare beneficiaries There are 4 groups of physicians and practitioners who will not be subject to MIPS –Those who are in their first year of Medicare participation. Participants in eligible Alternative Payment Models who qualify for the bonus payment . Those who have a patient volume below the low volume threshold- this number has not been defined. And most likely, federally qualified health centers and Rural health clinics.

Advanced Alternative Payment Models
(AAPMs) Let’s move on to APMs

Definitions Qualifying AAPM Participant Advanced APM Qualifying APM
Based on existing payment models Advanced APM Based on criteria of the payment model Qualifying AAPM Participant Based on individual physician payment or patient volume As we’ve mentioned, most providers will move through MIPS as they prepare to enter the Alternative Payment Model track. At the highest level, MIPS is based on existing activities with few entry requirements or exceptions making it easy to become a participant. Conversely, in the APM track, you must meet specific qualification and eligibility criteria. Let’s talk about what each of these mean.

Qualifying APMs MSSP (Medicare Shares Savings Program)
Expanded under CMS Innovation Center Model* Demonstration under Medicare Healthcare Quality Demonstrations (MHCQ) or Acute Care Episode Demonstration “Demonstration required by Federal Law” Qualifying APMs The goal is for you to be a Qualifying APM Participant. The first step to get there is to be practicing in a “qualifying” payment model defined in the law. MACRA is very specific about which models qualify, and they are listed here. Although this is a wide net cast for qualification it does get smaller as we move through the next steps of eligibility and further qualification.

Advanced APM Eligibility
Qualifying APMs Advanced APMs Quality measures comparable to MIPS Use of certified EHR technology More than nominal risk OR Medical Home model expanded under CMMI authority Step two in the process is for qualified APMs to meet eligibility criteria, listed here. Let’s take a closer look. First, Advanced APMs must report measures comparable to those in MIPS. Second, they must use certified EHR technology And, this last bullet is interesting. The APM needs to either 1) bear more than nominal financial risk for monetary losses, OR 2) be a medical home model expanded under CMMI authority. Nominal financial risk has been defined in the proposed rule and it is very complicated. The AAFP is advocating the definition be simplified.

Primary Care Advanced APMs
Shared Savings Program (Tracks 2 & 3) Next Generation ACO Model Comprehensive Primary Care Plus (CPC+) In the proposed rule, CMS defined those programs that met the criteria necessary to be considered an Advanced APM. They have said they will release an updated list of Advanced APMs annually.

Qualifying APM Participant
Qualifying APMs Advanced APMs Percentage of patients or payments thru eligible APM In 2019, the threshold is 25% of Medicare payments or 20% of beneficiaries QP status will be determined at the group level The last step after the payment model has been identified as an Advanced APM, is for the participants within the model to be qualified. Qualifying Participants (QPs) are physicians and practitioners who have a certain percentage of their patients or payments coming through an Advanced APM. In 2019 and 2020, the threshold for claims is 25% of payments made by CMS for part B services to Medicare attributed beneficiaries paid through the Advanced APM. The patient threshold is 20% of Medicare unique attributed beneficiaries. This is not a total percentage of your patient panel, this is just a percentage of your Medicare attributed patients. Beginning in 2021, the threshold percentage may be reached through a combination of Medicare and other non-Medicare payer arrangements, such as private payers and Medicaid Qualifying APM Participant

Additional Rewards for Qualifying Participants
Not subject to MIPS 5% bonus Higher fee schedule update to 0.75% 2026 Qualifying APM participants are excluded from MIPS, and will receive an annual 5% bonus payment from They will also receive a higher Medicare physician fee schedule update (of 0.75%) starting in 2026. Physicians and practitioners who participate in qualifying APMs that are not an Advanced APM are not a “qualifying participant” and will be subject to MIPS. However, APM participation is a clinical practice improvement activity, as defined under MIPS. As a result, these APM participants will receive favorable scoring for this performance category. QP Advanced APM

MIPS APM What if ??? My Advanced APM (MSSP Track 1) is not eligible??
Don’t meet QP threshold??

(MIPS) APM Scoring Standard
Quality Measures report through APM Cost 0% Indefinitely ACI Must report – same as all eligible physicians Improvement Activities Automatic 100% (annual review of model) *CMS will calculate the final score for MIPS APM at the APM Entity level. MIPS APMs are MSSP (All Tracks), Next Gen ACO and CPC+ All advanced APMs could be a MIPS APM but not all MIPS APM can’t be a advanced APM Still get credit –but fall back into MIPS – Different Scoring Mechanism within MIPS Use Measure reported to APM models as Quality, Cost is zero percent now and in the future 2017 will get 100% in IA - Will review model annually against improvement activities and score – possibly to attest to get higher score Only required to report ACI – will aggregate all score ups to APM entity level

MACRA Timeline 2017 2018 2019 2020 2021 2025 2026 +0% +/-9% 2022-2024
Medicare Part B Baseline Payment Updates +0.5% 0% +0.25%* +0.75%** *Non-qualifying APM Conversion Factor **Qualifying APM Conversion Factor Merit-Based Incentive Payment System (MIPS) PQRS, Value-based Modifier, & Meaningful Use Quality, Cost, Advancing Care Information, & Improvement Activities -9% -9%? 0 or +/-4%* “Pick Your Pace” +/-5% +/-7% Qualifying APM Participant 5% Incentive payment Excluded from MIPS +0% And finally, the full timeline. The timeline illustrates the payment updates, and the penalties and/or benefits by year for both MIPS and Qualifying APM Participants. This timeline is available on the AAFP website +/-9%

Partial Participation
What Can I Do Right Now? ‘Pick Your Pace’ Test Partial Participation Full Participation Advanced APM So, What Can You Do Right Now to take advantage of the payment opportunities?

Assistance is Available
Find a PTN Go to aafp.org/tcpi Click “Find a PTN” to find a practice transformation network in your area with any questions. If you are not already participating in an Advanced APM, take advantage of the technical assistance provided through the Transforming Clinical Practices Initiative (TCPI) This project is focused on positioning practices to “thrive as a business via pay for value approaches” by providing practice coaches, resources from quality improvement networks and quality improvement offices and other organizations in practice transformation. For more information go the AAFP website dedicated to this project or

For more information, visit our MACRAReady landing page which will be updated as we learn more.
FAQs Timeline MIPS/APM Comparison table Related articles Related links Check out Family Practice Management for up to date articles about MACRA, payment reform, and the practice transformation needed to get your practice ready for the new environment. FPM is a free resource online for members.

The Affordable Care Act: Full Repeal and Replace?
Almost impossible US House US Senate Supermajority in Senate needed to override a filibuster for ‘normal’ legislation

Questions to Consider How politically important are the coverage numbers? How much policy can be passed using the tactic of reconciliation? Will there be enough repeal to call the ACA “repealed”? How will political balance be achieved between states who expanded Medicaid and those that didn’t?

Key Issues in Health Reform
Coverage Numbers Cost Estimates Subsidies Premium Costs Preexisting Conditions Essential Health Benefits Medicaid Expansion States v. Non-Expansion States

AHCA + FY’18 Budget Impact on Medicaid

AHCA Impact on Medicaid

What is actually possible?
Rolling Back the Affordable Care Act What is actually possible? Dismantle Federal Revenues Stop Enforcing Regulations Stop defending the ACA in court Limit Funding Block payments meant to offset the financial risks faced by insurers. Taking away payments through the risk corridor or risk adjustment programs disincentives insurers from participating in the exchanges. Limit funding meant to promote sign-ups during open enrollment. Stop implementing or enforcing some of the ACA’s regulations. Such as: Restrictions on insurers offering plans with limited benefits Grant waivers to allow states to opt out of parts of the law Broaden hardship exemption to allow people to remain uninsured Congress has begun the process known as budget reconciliation to repeal provisions which affect federal revenues. Eliminate: ACA Subsidies Medicaid Expansion Medical Device Tax Cadillac Tax The Trump administration could choose to stop fighting the lawsuit the House GOP brought against the Obama administration. This would shut off subsidies for low-income patients. Without these incentives, insurance companies could drop out of the markets, essentially ensuring their collapse.

What is Worth Protecting?
The Affordable Care Act What is Worth Protecting? Physician workforce strategy where primary care is fundamental No patient should lose their coverage due to an action or inaction of Congress No discrimination based on pre-existing conditions, health care condition, family history, race, gender, or income Contraception and maternity care should be covered essential benefits $ Preventive care services and vaccines should be provided with no out-of-pocket costs Health insurance products should have uniform set of minimum benefits Viable and equitable safety-net program for low-income individuals No annual or life-time caps

What’s next for health care?
Will there be any more serious attempts to replace the ACA? Maybe. Any serious attempt would likely be a more minor, bipartisan, legislative fix to ACA Will Trump’s administration undermine ACA? Possibly. However, if Trump’s administration does cause the law to collapse, there will likely be significant political consequences Will Planned Parenthood be defunded in the government shutdown fight? Unknown. House will require, but legislation defunding PP will not pass the Senate Will CHIP be reauthorized in time? Will UFAs be negotiated in time? CHIP and other Medicare extenders will probably be passed together with FDA user fee agreements in a must-pass bill Reauthorization might be linked to revisitation of ACA – this could prove very difficult and endanger the rest of the package What about entitlement reform and drug pricing legislation? Medicare/Social Security reform is unlikely to occur in the next two years Drug pricing legislation is possible, but unlikely in the short term due to a number of other legislative priorities (e.g. tax reform, infrastructure) Will ACA taxes be repealed through tax reform? Unlikely – if tax reform is to be passed through budget reconciliation, the legislation must be budget neutral. As the GOP was unable to cut the programs that these taxes fund, they will also be unable to cut the associated taxes

Teaching Health Centers
Started with 63 residents; now have 742 residents and 59 THCs in 27 states 55% of residents stay in underserved area (vs. 26% nationally); 82% practice primary care (23% nationally) Expires 09/30/17; MACRA extended for 2 years 91 Members of the House request at least three year reauthorization in 04/12/17 letter

AAFP: MACRA-Ready Set Go New Mexico Academy of Family Physicians Annual Meeting July 27-30, 2017 Robert L Wergin MD, Past President AAFP.

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AAFP: MACRA-Ready Set Go New Mexico Academy of Family Physicians Annual Meeting July 27-30, 2017 Robert L Wergin MD, Past President AAFP.

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Presentation on theme: "AAFP: MACRA-Ready Set Go New Mexico Academy of Family Physicians Annual Meeting July 27-30, 2017 Robert L Wergin MD, Past President AAFP."— Presentation transcript:

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