- The American Medical Group Association (AMGA) has written House Speaker Paul Ryan (R-WI) to ensure that the transition to value-based care remains a focal point for the 115th Congress and that medical groups have the assistance they need to success in the Quality Payment Program.
“It is very clear that policymakers want to transform how health care is financed and provided,” writes AMGA President & CEO Donald W. Fisher, Ph., CAE. “Our priorities are based on the need to address the obstacles that are preventing providers from succeeding in a risk-based system that values and rewards quality instead of the volume of services provided.”
AMGA’s letter recommends a few key improvements deemed necessary for ensuring a successful MACRA implementation of value-based care models.
First, AMGA emphasizes the importance of giving providers access to claims data. Federal and commercial payers, the organization states, should provide access to all administrative claims data in order to make it easier for healthcare providers to manage the patient population. Managing a patient population requires providers have access to data to ensure the best course of action in improving patient care.
“Access to standardized claims data is of vital importance to providers. Without it, providers cannot reasonably care for and improve the health of a patient population,” Fisher states.
Second, AMGA recommends Congress work toward data standardization of to encourage system-wide interoperability — namely between providers and payers. A standardized data submission and reporting process will alleviate unnecessary administrative burden and streamline data reporting. The current protocol prompting medical groups to submit data to different insurance companies in a variety of formats diverts resources from providing patient care.
Finally, AMGA stresses the importance of giving providers access to capital in order to move embrace a value-based care system more readily. AMGA suggests providers be able to use income on a tax-free basis in investments funneled toward infrastructure that will cut down on downside risk. Access to capital would not only encourage risk and use of tax-free funds but also placate concerns over consolidation.
The transition to value-based care is already underway with 395,000 organizations in line to participate in Alternative Payment Models tailored to pay providers according to the quality of care they deliver to patients as opposed to the quantity of services they provide.
The AMGA also addressed three policy improvements to encourage a successful implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
First, AMGA recommends Congress adjust current policy dictating 2019 will not count Medicare Advantage revenue so that the latter may be considered in 2019 for Advanced Alternative Payment Model (APM) purposes to enable greater opportunities for participation in new care arrangements.
Next, Congress should work to adjust financial risk thresholds for Advanced APM statuses in order to account for potential lack of commercial risk products in local markets. Furthermore, accountable care organizations (ACOs) should not face penalties in areas lacking commercial risk products.
Lastly, the significant investments required of Track 1 ACOs for information technology and care process redesign should qualify them for Advanced APM status, claims AMGA. Presently only downside-risk ACOs can qualify as Advanced APMs despite all ACOs requiring multimillion-dollar investments in health IT, care process re-design, and staffing necessary to participate efficiently in value-based payment.
The organization also highlighted the importance of in-office ancillary services (IOAS) exception within the Stark physician self-referral law for multispecialty medical groups and integrated healthcare delivery systems.
Additionally, the letter emphasizes the importance of preserving Medicare Advantage, guaranteeing appropriate healthcare coverage, and improving graduate medical education, citing the importance of maintaining and building a large physician workforce to support the steadily growing patient population.