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MACRA News: When is an APM not an APM?
While it is clear that Congress intended to nudge physicians toward participation in alternative payment models (APMs) when it enacted the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), it is less clear which particular models Congress had in mind. Much will depend on how the Centers for Medicare and Medicaid Services (CMS) interprets the law in upcoming regulations – and specifically, how much financial risk CMS will require providers to accept to earn APM incentives.
The MACRA includes strong incentives for physicians who provide a significant amount of care through APMs – a bonus of five percent of their Medicare professional services payments in 2019 through 2024, exemption from the performance reporting requirements and payment adjustments under the Merit-based Incentive Payment System (MIPS) and beginning in 2026, a slightly higher annual increase to base Medicare rates than physicians paid through the MIPS. These incentives, plus the potential to share in savings realized under APM models, likely will result in increased interest in APM participation among physicians.
However, not all APMs are created equal under the terms of the MACRA.
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AHA shares suggestions for new physician payment models with Congress
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The American Hospital Association (AHA) recently submitted to the House Energy and Commerce Committee several overarching recommendations for the Merit-based Incentive Payment System (MIPS) and alternative payment models, which will affect Medicare physician fee schedule payments beginning in 2019 under the Medicare Access and CHIP Reauthorization Act of 2015. In a statement for a hearing on implementing the payment reforms, AHA urged the adoption of a MIPS that „measures providers fairly, minimizes unnecessary data collection and reporting burden, focuses on important quality issues and promotes collaboration across the silos of the health care delivery system.” To achieve this, the association said the Centers for Medicare & Medicaid Services (CMS) should streamline physician quality reporting measures and options; risk adjust rigorously where appropriate; allow hospital-based physicians to use their hospital’s quality reporting and pay-for-performance measures for the MIPS; and align Electronic Health Record Incentive Program changes for physicians with those for eligible hospitals while avoiding an „all-or-nothing” scoring approach. AHA also urged CMS to implement the alternative payment models in a manner that provides the greatest opportunity for physicians to become qualified participants, and adopt a broad exception to fraud and abuse laws that impede collaboration and improvement across the care continuum.
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CMS proposes to test alternative payment model for Medicare Part B drugs
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The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule to test new models for how Medicare Part B pays for prescription drugs provided in physician offices and hospital outpatient departments. Medicare Part B currently pays physicians and HOPDs the average sales price of a drug, plus a 6 percent add-on. According to a CMS factsheet, the proposed model would test whether changing the add-on payment to 2.5 percent plus a flat fee payment of $16.80 per drug per day changes prescribing incentives and leads to improved quality and value. CMS would update the flat fee at the beginning of each year by the percentage increase in the consumer price index for medical care for the most recent 12-month period. The test would begin in late 2016. In addition, the rule proposes to add certain value-based pricing strategies no sooner than 2017. These include varying the payment for a drug based on its clinical effectiveness; testing a standard payment rate for a group of therapeutically similar drug products; allowing CMS to enter voluntary agreements with drug manufacturers to link patient outcomes with price adjustments; and discounting or eliminating patient cost-sharing to improve access and appropriate use of effective drugs. CMS will accept comments on the proposed rule through May 9.
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Reminder: Applications due April 8 for AHA/AMGA fellowship to foster integrated care
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The AHA’s Physician Leadership Forum is collaborating with AMGA to create an opportunity for members to participate in a learning fellowship on managing population health and succeeding in the new physician payment models that take effect in 2019. The call for participation is available at www.ahaphysicianforum.org/fellowship.
The AHA-AMGA Learning Fellowship is a comprehensive program that addresses critical success factors such as leadership, culture, structure, execution, alignment, reimbursement, and physician compensation. Working together, we will provide participating organizations and their employed physicians with the skills and information to move from a traditional hospital-owned/employed model to a more organized, integrated system of care delivery for the purpose of managing population health. The fellowship will begin in July 2016 and end in October 2017. Submissions are due April 8, 2016.
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Next PLF webinar to focus on clinical learning environments and GME
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Join the AHA’s Physician Leadership Forum and the Accreditation Council for Graduate Medical Education (ACGME) on Wednesday, Apr. 27 beginning at 2:30 p.m. ET to learn about building excellence in clinical learning environments for graduate medical education.
Presenter Kevin B. Weiss, MD, MPH, senior vice president for Institutional Accreditation with ACGME, will discuss the purpose of the Clinical Learning Environment Review (CLER) program along with the core themes noted in the report of findings from the first cycle of nearly 300 CLER site visits. He will highlight some of the progress made toward engaging resident and fellow physicians to improve patient safety, health care quality, and other focus areas as well as high-leverage opportunities for improvement.
To register for this complimentary webinar, click here.
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HHS proposes raising physician prescribing limit for opioid treatment
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The Department of Health and Human Services (HHS) recently issued a proposed rule that would double the number of patients a qualified physician may treat with buprenorphine. The controlled substance is one of three drugs approved by the Food and Drug Administration for medication-assisted treatment of opioid dependence. According to an HHS factsheet, the Substance Abuse and Mental Health Services Administration rule would allow qualified practitioners to request approval to treat up to 200 patients a year if they have maintained an active waiver to treat up to 100 patients for a year and have subspecialty board certification in addiction medicine or addiction psychiatry, or practice in a qualified practice setting as defined in the rule. In addition, they would have to reaffirm their eligibility every three years; attest that they will adhere to evidence-based treatment guidelines; and provide or connect patients to necessary behavioral health services; among other conditions. The rule also would allow practitioners with a 100-patient limit to request to serve up to 200 patients for up to six months in an emergency.
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CDC updates Zika guidance, issues factsheets on pregnancy registry
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The Centers for Disease Control and Prevention (CDC) has released updated guidance for health care providers caring for women of reproductive age with possible Zika virus exposure, and for preventing sexual transmission of Zika virus. Women and men who may have been exposed to Zika from recent travel or sexual contact but do not have symptoms are advised to wait at least eight weeks before attempting conception to minimize risk. Women and men who have been diagnosed with Zika or have symptoms should wait at least eight weeks and six months after their symptoms appear, respectively, before attempting conception, the agency said. CDC also has issued factsheets on the U.S. Zika Pregnancy Registry, created to help public health officials understand more about Zika virus infection during pregnancy and congenital infection. Recent evidence suggests a possible association between maternal Zika virus infection and adverse fetal outcomes. Until more is known, CDC strongly advises pregnant women to consider postponing travel to Zika-affected areas. For more information, visit www.cdc.gov/zika and www.aha.org/zika.
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FDA allows use of investigational test to screen blood donations for Zika
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The Food and Drug Administration recently announced an investigational test to screen blood donations for Zika virus in areas with active mosquito-borne transmission of the virus. Once screening using the investigational test begins, blood establishments in Puerto Rico may resume collecting donations of whole blood and blood components, the agency said. „The availability of an investigational test to screen donated blood for Zika virus is an important step forward in maintaining the safety of the nation’s blood supply, especially for those U.S. territories already experiencing active transmission,” said Peter Marks, MD, director of the FDA’s Center for Biologics Evaluation and Research. „In the future, should Zika virus transmission occur in other areas, blood collection establishments will be able to continue to collect blood and use the investigational screening test, minimizing disruption to the blood supply.” The Centers for Disease Control and Prevention has released new maps of the United States that show the approximate and potential locations of the two species of mosquitoes that are associated with Zika transmission.
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HHS issues national pain strategy
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The Department of Health and Human Services recently issued a national strategy for improving pain care, which it called „the federal government’s first coordinated plan for reducing the burden of chronic pain that affects millions of Americans.” Developed by an interagency committee with input from a broad range of experts, and created in response to a 2011 Institute of Medicine report, the strategy includes recommendations in six areas: population research; prevention and care; disparities; service delivery and payment; professional education and training; and public education and communication. More specifically, it calls for developing methods to improve pain prevention and management, creating a system of patient-centered integrated pain management practices; removing barriers and improving pain care for vulnerable, stigmatized and underserved populations; and educating patients and the health care workforce about pain management. HHS plans to develop an implementation and evaluation plan for the strategy, which it called an essential element of the secretary’s initiative to address the opioid epidemic.
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CMS announces final application round for Next Generation ACO Model
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The Centers for Medicare & Medicaid Services’ Innovation Center is accepting the second and final round of applications for its Next Generation Accountable Care Organization (ACO) Model, which will begin its second performance year on Jan. 1, 2017. Participants in the model take on greater performance risk than those in current models, and may also share in a greater portion of savings. Eligible participants include physicians and other practitioners, hospitals that employ or have partnership arrangements with physicians or other practitioners, critical access hospitals, and rural health clinics. Applications are due May 25, with associated lists of providers and service areas due June 3. Interested organizations also must submit a letter of intent by May 2. Currently, 21 ACOs participate in the model.
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Applications being accepted for the ABMS Visiting Scholars Program
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The American Board of Medical Specialties (ABMS) Visiting Scholars Program is accepting applications for the 2016-2017 class. Junior faculty, PhDs, residents/fellows, medical students, public health students, and graduate students in health services research and other relevant disciplines are invited to apply to participate in this exciting and dynamic, one-year, part-time program facilitating research projects designed to improve patient care. In addition to the research project, scholars are exposed to the fields of professional assessment and education, health policy and quality improvement and are offered the opportunity to develop leadership skills critical to their own professional growth and success. Scholar’s research should build on existing projects at their institution and generate data, tools and activities that could be useful to specialty boards in the Board Certification and Maintenance of Certification/Continuing Certification process. For more information about the program and the application process, contact ABMS at [email protected].
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Register today for AHA’s Annual Meeting
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Will your organization compete or partner with disruptive innovators? How can your organization improve community health through collaborative partnerships? Learn the business case for bringing more women onto boards. Connect with fellow trustees and gain insights on key issues for trustees at AHA’s Annual Meeting May 1-4. Team discounts are available for four or more.
For more information or to register, click here.
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FEATURED RESOURCE
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Physician Organization Governance: Transformation and Three Perspectives
For more resources, visit our website.
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MOST POPULAR
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The most popular article from our last issue:
CDC issues final opioid prescribing guidelines for adults with chronic pain
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Physician Leadership Forum
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