Ten groups, including the American Medical Association, the Medical Group Management Association and the American College of Surgeons, sent a letter to CMS Administrator Seema Verma requesting that Medicare Advantage (MA) be treated as an alternative payment model (APM) under MACRA starting in 2019.
For 2019 and 2020 payment adjustment years, current regulations say that only Medicare Fee for Service (FFS) revenue and patients will be counted in the Quality Payment Program's Advanced APM test, the authors wrote. MA isn’t part of the program until 2021. In their May 31 letter, the groups requested that CMS include MA for the 5% Quality Payment Program bonus in 2019 and 2020 for “MA plans that meet the risk, quality and certified electronic health information technology requirements.”
Despite nearly one-third of Medicare beneficiaries enrolled in MA, “leading edge clinicians who take risk under APMs within these MA contracts will not get credit for their efforts until 2021,” wrote the groups.
MACRA will move Medicare from a FFS system to a value-based model. It will eliminate the sustained growth formula and replace it with a .5% annual rate increase through 2019. At that point, physicians will be encouraged to shift to one of two Quality Payment Programs: Merit-Based Incentive Payment System (MIPS) or an APM.
QPP offers providers a 5% bonus on covered professional services under the Medicare physician fee schedule from 2019 through 2024 — as long as they meet or exceed minimum revenue thresholds. MA isn’t part of the program until 2021.
By adding MA, the groups wrote, CMS would get more participation in risk arrangements, reinforce population-based strategies, improve quality and get more efficient care in Medicare.
“Moreover, it will level the playing field between geographic areas with high MA penetration and those with low penetration, to ensure more uniform adoption of these types of models for Medicare beneficiaries," the authors wrote. "While we do not expect the inclusion of these contracts to amount to a significant increase in spending from a national expenditure perspective, this policy change will be critical for bringing clinicians in certain areas into Advanced APMs and will be key to their success.”
The groups said having two different payment models for Medicare could raise problems. They stated research on physician participation in new payment models has discovered that having multiple requirements from different payers “is a strong disincentive to broader participation in these models and can also reduce the ability of physicians to improve quality and reduce spending.”
Having different requirements leads to varied goals, quality metrics, performance feedback reports, payment models, benchmarks and risk adjustment models. These conflicts mean more time and costs for providers and less time spent on patient care, according to the groups.
MACRA is almost here, but not everyone is ready. A recent survey found that nearly two-thirds of providers aren’t ready for it or need help.
In addition, a recent Health Affairs study found Medicare hospital reimbursement could decrease $250 billion over a 15-year period under MACRA. The researchers used four scenarios and found that physicians might take a financial hit as they get used to the different value-based payment model. MACRA is also expected to cut hospital admissions and re-admissions.