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June 8, 2017

ACO roundup: Health groups urge CMS to qualify MA contracts as APMs

Daily Briefing
  • Health groups say MA contracts should qualify as APMs under MACRA. The American Medical Association and nine other health care groups in a letter sent last week urged CMS Administrator Seema Verma to allow certain Medicare Advantage (MA) contracts to qualify as Advanced Alternative Payment Models (APMs) under MACRA. In the letter, the groups called on Verma to modify CMS regulations to allow MA contracts that meet MACRA's Quality Payment Program's (QPP) risk, quality, and certified electronic health record requirements to qualify as Advanced APMs under MACRA in 2019 and 2020. According to the groups, allowing MA contracts to qualify as Advanced APMs in 2019 and 2020 would align financial risks and payments under QPP, which would facilitate physicians' participation in the programs because they would not have to "manage multiple and conflicting requirements from different payers."

  • Two physicians clash on whether quality reporting can improve health care. Two physicians in separate articles in the Annals of Family Medicine detailed their opposing views on whether quality reporting can help to improve health care outcomes and physician performance. In one article, David Scrase, a physician at the University of New Mexico Medical School, writes that quality reporting ultimately made him a better physician—although he also acknowledges the importance of making quality reporting more effective. Meanwhile, David Hahn, a physician at the University of Wisconsin School of Medicine and Public Health's Department of Family Medicine and Community Health, in a separate article argues that quality reporting has limited potential to improve health care, saying quality measures are determined arbitrarily and are based on opinions instead of evidence.

  • Almost all Advanced APM clinicians will qualify for incentives, CMS says. CMS last week estimated that nearly 100 percent of clinicians who participated in Advanced APMs in 2016 would qualify for incentive payments in 2019 if they participate in the models this year. According to AHA News, under MACRA, eligible providers who participate in at least one Advanced APM in 2017 and get either 20 percent of their Medicare patients or 25 percent of the Medicare reimbursements via an Advanced APM can qualify for a 5 percent incentive payment in 2019. CMS used administrative claims data from last year to calculate the 2017 qualifying statuses, AHA News reports.

From Advisory Board:

  • Why the physician network needs to be redefined—and how to do it. In recent years, physician networks have focused primarily on growing market share, improving quality, and preparing for population health. Today's networks, however, must simultaneously accomplish several different goals—and manage inherent tensions along the way. Join us on June 26 to learn how to effectively segment physicians across the network and instill a clear sense of individual purpose to help physicians in the network better advance system strategy.

Register Here

Register Here

  • How to assemble a high-performing PAC partner network. This webconference will provide guidance for developing a more systematic post-acute care network strategy. Join us on June 14 to learn the seven strategic steps health systems should take when assembling high-performing PAC networks.

Register Here

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