Newsletter for Members and Partners October 10, 2019
Miss Something at the Conference? Miss the Whole Conference?
HHS Proposes New Stark and Anti-Kickback Waivers for Value-Based Care
MSSP ACOs Recorded Tremendous Savings in 2018
CMS Pays Advanced APM Bonuses
2019 Promoting Interoperability Deadlines
NAACOS Submits Comments to CMS on Medicare Physician Fee Schedule Rule
President Signs Executive Order on Medicare
Amy Bassano Named Acting Director of CMMI
NAACOS On Capitol Hill
MARK YOUR CALENDAR! NEXT BOOT CAMP ON ACO RISK-TAKING
Join your ACO colleagues for the next boot camp in our very popular and successful series designed to give ACOs the tools they need to succeed with greater risk. Our next boot camp is planned for February 2020 in Orlando, Fla. As CMS encourages its ACOs to take on greater risk, this boot camp will show ACOs how to implement the essential tools for financial success in risk-based ACOs. Boot camp faculty will use case studies, labs, and small group exercises to create an interactive and highly educational format. More information coming soon!
MISS SOMETHING AT THE CONFERENCE? MISS THE WHOLE CONFERENCE?
The NAACOS Fall 2019 Conference is being recorded in its entirety, and the recordings will be available online or on flash drive. Participants can purchase the recordings for $100 at the conference registration desk. Following the conference, recordings may be purchased by contacting Emily Perron at 202-640-2674 or at [email protected].
HHS PROPOSES NEW STARK AND ANTI-KICKBACK WAIVERS FOR VALUE-BASED CARE
On October 9, 2019, the U.S. Department of Health and Human Services (HHS) published long-awaited draft regulations concerning the application of federal fraud and abuse laws to value-based care arrangements. Specifically, the HHS Office of Inspector General (OIG) published a proposed rule on the federal anti-kickback statute (AKS), and the Centers for Medicare and Medicaid Services (CMS) published a proposed rule on the physician self-referral law (Stark). Both proposals aim to reduce the regulatory burden imposed by application of the federal AKS and Stark Laws to arrangements outside the context of fee-for-service Medicare, and they are part of HHS’s wider effort to transition to value-based care arrangements. On a stakeholder call following the announcement, CMS staff clarified that the agencies’ proposals will not alter the existing Stark and AKS waivers currently in place for Medicare Shared Savings Program (MSSP) ACOs.
NAACOS previously submitted comments in response to the administration’s 2018 requests for information on Stark Law and anti-kickback statute waivers, and these new rules are based on feedback obtained from the requests for information. NAACOS issued a statement following the release of the rules expressing support for the administration’s efforts to enhance value-based care, giving ACOs and other models tools needed to succeed, improving regulatory certainty, and reducing administrative burden. Comments on both rules will be due 75 days after publication in the Federal Register, which will likely occur later this week or early next week. We are reviewing both proposals in detail and plan to provide comments to the agencies; please email [email protected] if you have any specific feedback you would like us to consider.
MSSP ACOS RECORDED TREMENDOUS SAVINGS IN 2018
MSSP ACOs collectively saved Medicare $1.7 billion last year alone, and $739 million after accounting for shared savings bonuses and collecting shared loss payments. These 2018 results represent a strong, steady trend of continuous improvement in bending health care’s cost curve. According to CMS data, 66 percent of the 548 MSSP ACOs saved Medicare money in 2018, and 37 percent saved enough money to earn shared savings bonuses. MSSP cared for 10.1 million beneficiaries last year. Importantly, ACOs also had an average quality score of almost 93 percent.
Other important data:
- ACOs that joined MSSP in 2016 or 2017 improved their quality measure performance by an average of 27 percent in 2018.
- Those who earned shared savings retained an average of 48 percent of their generated savings.
- ACOs that received shared savings payments had decreases in inpatient, emergency room, and post-acute care spending and utilization.
- ACOs in their second contract period (N=243) generally saved more than twice as much per beneficiary compared to ACOs in their initial contract period (N=305), showing savings increases over time.
CMS Administrator Seema Verma announced the results in a Health Affairs blog, and NAACOS issued a press release, which has helped generate numerous positive media reports. We are excited for 2018 performance data to be released on the Next Generation ACO Model. NAACOS is proud of the work ACOs are doing in hitting their goal of lowering Medicare spending while improving quality. As a reminder, ACOs are required to post certain annual performance results on their public websites.
We encourage you to issue press releases about your results and share performance with your elected representatives in Congress, if you haven’t done so already. NAACOS is analyzing additional results and will release a thorough resource. Congratulations, again, on a great year!
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Virginia Care Partners ACO, LLC Health Leaders Medicare ACO Network |
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CMS PAYS ADVANCED APM BONUS
CMS recently issued payment to providers who participated in Advanced Alternative Payment Models (Advanced APMs) in performance year 2017 and met other requirements. Congress created the Advanced APM bonuses in the landmark 2015 law, the Medicare Access and CHIP Reauthorization Act (MACRA), as a reward for participation in risk-bearing payment models, like certain ACOs, designed to lower healthcare spending. NAACOS and other organizations recently urged CMS to release these payments for 2017, the first performance year the incentive was available. Additionally, NAACOS requested that CMS commit to pay these bonuses no later than June 30th in future years. More than 90,000 clinicians are owed the bonus this year; a number CMS predicts will increase in future years.
Along with announcing the payments, CMS posted a new 2019 APM Incentive Payment Fact Sheet. It’s important to note that the APM Incentive Payment is based only on Part B covered professional services (services paid under the Part B physician fee schedule as well as certain payments noted in the CMS fact sheet) and not all Part B items and services. The factsheet also explains:
- Who is eligible to receive an Advanced APM incentive payment in 2019,
- How CMS determines the 2019 Incentive Payment, and
- Answers to frequently asked questions.
CMS also notes that later this fall providers will be able to verify their APM Incentive bonus information by going to the Quality Payment Program Portal that will show information about the incentive payment amount and other details. Additional information on qualifying for the bonus is detailed in NAACOS’s ACO Guide to MACRA.
2019 PROMOTING INTEROPERABILITY DEADLINES
ACOs subject to the Merit-Based Incentive Payment System (MIPS) must report for at least 90 continuous days to meet Promoting Interoperability (PI) performance category requirements for 2019. This means October 3, 2019, was the last day to begin the 90-day performance period for PI. As a reminder, PI data will be submitted in January to March of 2020; the submission window will close on March 31, 2020. For more information on PI requirements, access our ACO Guide to MACRA.
NAACOS SUBMITS COMMENTS TO CMS ON MEDICARE PHYSICIAN FEE SCHEDULE RULE
NAACOS submitted its comments to CMS in response to the proposed 2020 Medicare Physician Fee Schedule Rule. The comment letter includes a number of recommendations to CMS proposals on ACO quality changes, updates to the Quality Payment Program for 2020 and other issues. Key recommendations included requests for CMS to:
- Not align MSSP quality scoring methodologies with MIPS quality scoring methodologies. Instead, CMS should focus on improving MIPS methodologies in quality comparisons and separately continue to work with ACOs to refine the ACO quality measure set, developing the most appropriate measures for providers in total-cost-of-care models;
- Not finalize the proposal to add ACO-47 to the MSSP quality measure set for 2020. Instead, we urge CMS to maintain the current vaccination measure ACO-14, Preventive Care and Screening Influenza Immunization, with modifications to reduce data collection burdens;
- Make ACO-17, Smoking Cessation, pay-for-reporting in both 2018 and 2019 and finalize changes to the measure specification requirements that better reflect clinical practice;
- Finalize proposals to roll back the agency’s policy to collapse office/outpatient Evaluation and Management (E/M) Levels 2, 3 and 4 codes, and instead implement a proposed new framework recommended by provider stakeholders;
- Implement care management changes to enhance the use and value of care coordination and care management services, but avoid short-term disruptions from temporary use of G-codes;
- Not finalize new Principal Care Management services for patients with one chronic condition as these proposed codes would lead to duplicative care management by focusing on disease-specific, rather than whole-person, care management
The complete letter is available on our website. Thank you to our members for your feedback on these important issues.
PRESIDENT SIGNS EXECUTIVE ORDER ON MEDICARE
The White House recently issued an executive order that, if executed, would create several changes to Medicare, both fee-for-service and Medicare Advantage. Among the wide-ranging actions, the order directs HHS to adjust supplemental Medicare Advantage benefits to allow beneficiaries to share more directly in savings from the program through incentives to seek high-value care; identify ways to align fee-for-service payments with that of the commercial market; examine and eliminate barriers to the practice of non-physician practitioners; and submit a report that makes recommendations on the transition toward a “true market-based pricing” system within Medicare fee-for-services. The order also directs HHS to use Medicare claims data to give providers additional information on practice patterns that pose undue risks to patients or are outside recommended standards of care. The order, signed on October 3, is a reaction to recent calls for “Medicare for All,” by strengthening the current Medicare Advantage program. Next steps for this executive order include HHS proposing regulations and implementing administrative actions to carry out these changes.
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AMY BASSANO NAMED ACTING DIRECTOR OF CMMI
Adam Boehler recently left his position as the CMS deputy administrator and director of the Center for Medicare and Medicaid Innovation (CMMI) to assume another role in the Trump administration. Following his departure, Amy Bassano was recently named Acting Director of CMMI, a position she previously held prior to Boehler’s tenure. Ms. Bassano has also served as CMMI’s deputy director since 2016 and will serve in the Acting Director position until a new director is named.
NAACOS ON CAPITOL HILL
On September 24 and 25, NAACOS members from 18 states met with 80 Capitol Hill offices to discuss how Congress can improve the ACO program. Roughly 20 of those meetings were with Members of Congress. We also had 39 meetings with offices on the Senate Finance, House Ways and Means, and House Energy and Commerce Committees. These committees are especially important to our advocacy efforts since they have primary jurisdiction over Medicare and health care programs. We will be using these meetings to continue building support for legislation NAACOS has been developing with our coalition partners that will strengthen Medicare’s ACO and Quality Payment Program.