Implementation of MACRA will impact not only physicians, but also the hospitals with whom they partner, the American Hospital Association told Andy Slavitt, acting administrator of CMS, and the U.S. House Ways and Means Subcommittee on Health on Wednesday.

Health Subcommittee members met with Slavitt Wednesday on the implementation of the Medicare Access and the CHIP Reauthorization Act of 2015.

MACRA’s Quality Payment Program, released by CMS on April 27, consolidates a patchwork of programs into two paths for physicians receiving Medicare payments: the Merit-based Incentive Payment Systems (MIPS); and an Advanced Alternative Payment Model (APM).

The AHA said it applauds MACRA’s streamlining of the physician reporting burden, but still has concerns, especially for smaller practices, and is disappointed the federal government is providing no financial incentives for upfront investments in technology to meet the demands of implementation.

The estimated investment is $11.6 million for a small accountable care organization and $26.1 million for a medium ACO, the AHA said.

[See also: A deep dive on the ‘overwhelmingly complex’ MACRA proposed rule.]

“Hospitals that employ physicians directly may bear the cost of implementation of an ongoing compliance with the new physician performance reporting requirements under the Merit-based Incentive Payment Systems, as well as be at risk for any payment adjustments,” the AHA said in a statement. “Moreover, hospitals may be called upon to participate in alternative payment models so that the physicians with whom they partner can qualify for bonus payments and exemption from MIPS reporting requirements that accompanies the APM ‘track.'”

House Ways and Means Subcommittee on Health Chairman Pat Tiberi, R-Ohio, asked Slavitt about concerns he’s heard about the difficulty smaller practices may have coming into compliance, saying the rural provider, and one or two-person provider group “has a bunch of angst right now.”

Slavitt said the data shows that smaller and solo practices can succeed as well as physicians in larger-size groups as long as they report. It’s up to CMS to make the reporting burden as easy as possible, Slavitt said.

“Importantly we are looking for additional steps and ideas as people review the rules, but I will say that we are focusing on technical assistance, providing access to medical home models, opportunities to report in groups and using a reporting process that automatically feeds data, reduces the number of measures and overall lowers the burden for small practices,” Slavitt said.

Small physicians can report in groups and other physicians may not have to report at all because they’re under a minimum threshold for the number of Medicare patients they see, Slavitt said.

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