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CONGRESS PASSES PARTIAL ADVANCED APM INCENTIVE EXTENSION
On December 23, Congress passed an omnibus funding bill that included a one-year extension of advanced Alternative Payment Model (APM) incentive payments at 3.5 percent while also maintaining
qualifying thresholds. Although the extension does not maintain the full 5 percent incentive, this temporary extension ensures value-based care providers will be eligible to qualify for
incentives in Performance Year (PY) 2023 (i.e., Payment Year 2025). This will help maintain momentum on the movement to value and gives stakeholders more time to work with the next Congress on
long-term solutions that improve value-based care. NAACOS would like to thank our members for all your efforts to highlight the importance of this issue on Capitol Hill. A NAACOS
press release is available.
MONTHLY GOVERNMENT RELATIONS CALLS TO CONTINUE IN 2023
Earlier this year, the NAACOS government affairs team began holding monthly calls for our members’ in-house or contracted government relations teams. These calls are an informal forum for
sharing updates on congressional outreach and materials that can be used in congressional meetings. The calls are scheduled for 2:00 pm ET on the third Thursday of each month. The next call is
scheduled for Thursday, January 19. Contact Robert Daley to have your organization’s in-house
or external government relations team join.
UPCOMING NAACOS POLICY WORKGROUPS
NAACOS is convening time-limited workgroups to develop recommendations on several key policies areas. These workgroups are launching January 2023. Please review and let us know if you or
someone from your team would like to participate in the workgroup. We are looking forward to hearing from our members on these critical topics.
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The Specialist Engagement in ACOs Workgroup will develop policy recommendations in response to the Center for Medicare and Medicaid Innovation’s (CMMI) strategy to support
person-centered, value-based specialty care. Contact
Jennifer Gasperini to participate.
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The Benchmarks Workgroup will develop solutions to benchmark challenges, including accounting for regional variation in spending, how to set fair risk adjustment policy, and the
pathway to administrative benchmarks. Contact David Pittman to participate.
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The Patient Engagement Workgroup will seek to understand how ACOs are engaging patients and their ACO patient board representatives, sharing best practices, and leveraging this
information for ACO advocacy. This group will meet every other Monday from 3:00–4:00pm ET beginning January 9, 2023. Contact
Alyssa Neumann to participate.
BUDGET INCLUDES LONG LIST OF HEALTH POLICY CHANGES
Congress passed an omnibus appropriations bill before the holidays that
extends government funding through September 30, 2023. A
section-by-section summary that includes highlights of the bill’s health
provisions is available. The bill provides a total of $4.1 billion for CMS administrative expenses, an increase of $100 million above the Fiscal Year (FY) 2022 enacted level. It also includes
$1 million for the Secretary of HHS to establish and maintain a report on best practices of population health management through the creation of a population health task force.
The omnibus funding bill also included many changes to Medicare and Medicaid, including:
- Waives statutory PAYGO requirements that would have resulted in 4 percent across the board cuts to Medicare.
- Increases Medicare physician fee schedule payments by 2.5 percent in 2023 and 1.25 percent in 2024 to partially offset reductions to the fee schedule conversion factor.
- Provides a two-year extension of Medicare telehealth flexibilities, the hospital at home program, low-volume hospital payments, and the Medicare-dependent hospital program.
- Delays by one year pending payment reductions and data reporting periods for clinical labs.
- Establishes Medicare coverage for services provided by marriage and family therapists and licensed professional counselors.
- Supports physician workforce development by providing for the distribution of 200 additional Medicare-funded graduate medical education (GME) residency positions.
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Adds a new exception to the Stark Law to allow for hospitals and other entities to provide evidence-based programs for physicians to improve their mental health, increase resiliency,
and prevent suicide among physicians.
- Extends funding for the Children’s Health Insurance Program (CHIP) for two years through fiscal year 2029.
- Requires children to be provided with 12 months of continuous coverage in Medicaid and CHIP effective January 1, 2024.
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To offset some of the costs associated with these policy changes, the budget extends the Medicare sequester for the first six months of FY 2032, while revising Medicare sequestration
percentages to 2 percent for FY 2030 and FY 2031.
The 118th Congress will convene on Tuesday, January 3. New members will be sworn in, and the House will hold votes to elect a new speaker.
CMS PROPOSES MEDICARE ADVANTAGE POLICY UPDATES
CMS recently proposed numerous changes to Medicare Advantage and Part D plans that, if finalized, would mostly take effect in 2024. Proposed changes include:
- Adding a health equity index reward to the Star Ratings System starting in 2027,
- Making several updates to the prior authorization process,
- Placing new requirements on plans’ marketing, and
- Adding certain behavioral health workers to plans’ network adequacy requirements.
Comments are due February 13. The rule,
fact sheet, and
press release are all
online.
QUALITY REPORTING TO OPEN JANUARY 3
CMS recently posted new resources to assist ACOs reporting Web Interface (WI) quality measures in advance of the reporting period opening on January 3, 2023. The 2022 WI Data Dictionary,
Support Flyer, User Guide and Excel Template with Sample Data have all been posted to the
Quality Payment Program (QPP) Resource Library. To access the files, visit the QPP resource library and use the
search function, entering the title of resource you want to access. ACOs can report 2022 quality data via the QPP portal starting on
January 3, 2023, and the last day to submit data is March 31, 2023. There are no substantive changes to 2022 WI measure specifications; however, ACOs should review annual coding updates which
are reflected in the WI supporting documents. Note there are substantive changes to 2022 measure specifications for electronic clinical quality measures (eCQMs) and Merit-Based Incentive
Payment System (MIPS) CQMs. Review specification guidelines carefully, which differ based on reporting method chosen. As a reminder, in PY 2022 there are no quality bonus points available to
ACOs. NAACOS will hold a webinar in February to review key points to consider in the quality reporting process; registration information will be shared shortly.
More information on quality requirements for ACOs is available.
CMS RELEASES ECQM/MIPS CQM GUIDANCE FOR ACOS
CMS has posted a new resource for ACOs on reporting eCQMs and MIPS CQMs. The resource
includes new guidance for ACOs, including recommendations on de-duplication and data completeness for ACOs reporting eCQMs or MIPS CQMs. Additionally, the resource includes new guidance that
all participant Tax Identification Numbers (TINs) must use Certified EHR Technology (CEHRT) in order to report eCQMs as an ACO. To share your feedback on this guidance, please email us at
[email protected]. NAACOS will continue conversations with CMS to ensure that ACOs have clear guidance for
moving forward with implementation of eCQM/MIPS CQM reporting.
OTHER CMS UPDATES
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CMS updated its Quality Payment Program Participation Status Tool based on the third snapshot of APM data. The third snapshot includes data from Medicare Part B claims with dates of
service between January 1 and August 31.
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CMMI released two new resources related to the Enhancing Oncology Model: those related to the model’s health equity strategy, including the new Enhanced Service requirement, and the
implementation of electronic patient reported outcomes.
NEW “DISCOVERY CALLS” COMING IN JANUARY
The NAACOS education department is working hard to bring you three discovery calls in January 2023 on topics of interest brought to our attention via the NAACOS Listserv. We are currently
pinning down the dates to hold calls on end-of life planning documentation prompting in the electronic health record (EHR), adding claims information into EPIC, and tracking hierarchical
condition category (HCC) gap scores in EHRs. More information on how to attend these events will be coming in the next issue of the NAACOS Newsletter and will be posted to the Listserv within
the next two weeks. These discovery calls are very informal with one or two brief presentations from ACOs followed by an open discussion forum. This platform allows ACOs to connect with others
who are working on the same types of initiatives to gather experiences for better advancements and outcomes. While we cannot cover every topic, the discovery calls also provide a space to
understand if the topics require additional educational support through NAACOS webinars, conference or boot camp sessions, or a much deeper dive via a NAACOS Learning Lab.
AGENDA NOW AVAILABLE FOR THE WINTER 2023 BOOT CAMP
Join us at the Marriott Orlando Airport Lakeside, February 9–10, 2023, for the Winter Boot Camp. The boot
camp will provide expert insight into the core competencies for ACOs. Faculty from top-performing ACOs, including Baylor Scott & White, Geisinger Health, Trinity Health, ChristianaCare,
and NOMS, will present clinical and operational strategies for success in any value-based care model. Participants will learn about clinical improvement models, their outcomes, and
implementation tips and tricks. The format will include presentations by clinical and operational leaders in accountable care, along with case studies and peer-to-peer learning.
Full agenda is now available!
Register NOW!
**This boot camp will only be offered in person. There will be no virtual option. Boot camps are not open to business partners. Space is limited to 100 people.**
REGISTRATION IS NOW OPEN FOR SPRING 2023 CONFERENCE
Join us May 3–5, 2023, for the NAACOS Spring Conference at the Hilton Baltimore Inner Harbor. This two-day, in-person event with pre-conference activities will feature the insights of CMS
officials, ACO leaders, and policy insiders, and also provide networking opportunities for participants, speakers, and vendors. Virtual and in-person registration options are available and, as
always, the entire conference will be recorded. Register early and save! Register before March 17 for the in-person or virtual
conference and receive a discount.
Exhibitor and sponsor opportunities are now available! The conference will feature exhibitors with products and services specifically for the accountable care community.
Partners reserve your space today!
JANUARY WEBINARS FROM NAACOS AND ITS PARTNERS
Beneficiary Notification
In addition to the discovery calls for ACO members, we are also organizing a webinar on the beneficiary notification processes for MSSP prospective and preliminary prospective attribution
models. This webinar will provide examples from ACOs who have processes in place and provide a forum to answer some of your questions. Watch for emails on this event as well as our next
newsletter.
Care More, Code (More) Accurately with Provider Engagement
Join us on January 24 at 2:00 pm ET for a one-hour webinar to hear and learn from BJC’s Dr. Nathan Moore, Medical Director, and Shannon Forman, Clinical Documentation and Quality Supervisor,
about BJC’s successful HCC journey with a focus on provider engagement and education, despite having no incentives in place. For a typical health system, HCC coding can be inadequate,
providers are expected to be coders (which they are not), and what’s more…they are NOT incented to improve coding accuracy. BJC Healthcare was driven to improve its HCC coding and tried a
new approach with proven clinical decision support technology embedded in the EHR workflow, that is delivered directly to physicians at the point of care. Attendees will learn to engage
providers and offer education, how to help physicians get involved in the coding process, how BJC provided a change management pathway for HCC success, and how an HCC solution can provide
smart coding.Sign up today!
Managing Your Post-Acute Spend: The Cost of Doing Nothing
Join us on January 30 at 2:00 pm ET for a one-hour webinar to hear and learn from Real Time Medical speakers Phyllis Wojtusik, RN, and Margie Latrella, APN-C, about the clinical and financial
impact of “doing nothing” when it comes to post-acute spend, including missing out on quality of care, not knowing your network performance, and losing potential shared saving dollars on
post-acute care (PAC) patients. In a value-based care world, ACOs are accountable for the entire patient journey; therefore, their long-term success and financial viability are inherently tied
to the performance of their PAC providers. As the ACO/PAC landscape begins to transform with many ACOs now building preferred PAC networks, there is still a lot of work to be done in creating
successful care coordination efforts that align with value-based care initiatives and incorporate effective care transitions, clinical pathway standards of care, risk stratification,
appropriate length of stays, and reduced readmissions. Phyllis and Margie will also highlight how live post-acute data analytics can help reduce total cost of care while enabling a better
quality of care and achieving value-based outcomes. Sign up today!
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WHAT WE’RE WATCHING: NEWS ABOUT ACOS AND HEALTH CARE
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