NAACOS SPRING CONFERENCE GOES VIRTUAL To safeguard the health of participants and the general public, the NAACOS Board of Directors has made the difficult decision to make the NAACOS Spring Conference a virtual event. The conference will begin on April 2 at 8:30 am ET as planned and conclude by 3:30 pm ET on April 3. The plenaries and all 15 breakouts will be webcast live. Those registered for the conference will automatically be registered for the livestreamed event and will also receive access to the recording of all conference sessions. If you have not yet registered for the conference, it’s not too late! Register now
The program for the spring conference has important information essential for critical decisions your ACO will make over the next few months. In addition, the conference will include new content that addresses some of the current ACO challenges presented by the coronavirus, as well as updates from CMS officials. As in the past, we will offer continuing education credits for approximately 10 hours.
HHS PUBLISHES FINAL RULES TO SPUR PATIENT-DATA SHARING NAACOS was pleased to see a pair of final rules from CMS and HHS’s health IT office that aim to make it easier to share patients’ medical records. The so-called “information blocking” or interoperability rules implement parts of the 21st Century Cures Act of 2015, which allow HHS to punish entities that block the flow of patient data. Among the many provisions of the final rules, hospitals are now required to share electronic notifications of patients’ admission, discharge and transfer (ADT) to inpatient facilities. Following NAACOS advocacy, CMS added a requirement to include patient visits to emergency departments as part of the requirement. Other provisions mandate the use of application programing interfaces for patients to access their medical records. HHS also set exemptions for when it’s okay to not share patient records with others.
NAACOS made it a priority last year to urge CMS to finalize its ADT-sharing requirement of hospitals, and we thank everyone who submitted comments to CMS in favor of the proposed rule. NAACOS continues to review the two final rules and plan to publish a summary for members later this month. View the final rules here and here as well as CMS’s fact sheet and a website explaining the final rules.
KEY DATES OUTLINED FOR DIRECT CONTRACTING CMS published a timeline outlining key dates for the Direct Contracting Model. In a helpful chart, the agency also compare those dates with the Medicare Shared Savings Program (MSSP). The application period for Performance Year 1 opens on March 31 and closes on May 1. The deadline is before CMS plans to publish details on benchmarking, risk adjustment and other financial methodologies. Also, September 22 is the last chance to notify CMS of your ACO’s intent to withdraw from the Shared Savings Program. This aligns with when the final provider list is due from Direct Contracting Entities. In a recent letter to CMS, NAACOS advocated for the alignment of timelines and participation deadlines across the two models to the greatest extent possible to help providers weighing their participation options between the two.
CONGRESS PROVIDES EMERGENCY FUNDING TELEHEALTH WAIVERS FOR CORONAVIRUS RESPONSE President Trump signed an emergency appropriations package into law last week that will fund the federal government’s response to the coronavirus. The bill provides $7.76 billion to federal, state and local agencies to combat the coronavirus and authorizes the Secretary of HHS to waive certain Medicare telehealth restrictions during the coronavirus public health emergency. These waivers would allow Medicare providers to furnish telehealth services to Medicare beneficiaries regardless of whether the beneficiary is in a rural community. This provision would also allow beneficiaries to receive care from physicians and other practitioners in their homes. NAACOS has long supported legislation that expands access to telehealth services and looks forward to working with CMS as the agency implements these waivers.
POTENTIAL CORONAVIRUS EFFECT ON ACO PERFORMANCE On top of the numerous public health concerns related to Coronavirus (COVID-19), NAACOS is already considering potential disruptions to ACO performance with unexpected changes to healthcare spending from COVID-19 creating a mismatch between benchmark and performance year spending. In response to a recent inquiry, the Innovation Center explained it is monitoring events and will later determine whether to make modifications for Next Generation Model ACOs. The center also pointed to language in Section XIII.B.1 of the Next Generation Model participation agreement, which discusses benchmarking:
“1. CMS may, at CMS’s sole discretion, retroactively modify the projected trend used in calculating the Performance Year Benchmark if CMS determines that exogenous factors, such as a natural disaster, epidemiological event, legislative change and/or other similarly unforeseen circumstance during the Performance Year, renders the projected trend invalid for assessing the expected level of spending between the Base Year and Performance Year in the population of NGACO reference beneficiaries, as such term is defined in Appendix B of this Agreement.”
NAACOS is awaiting a response from the MSSP about whether there will be any MSSP modifications to account for COVID-19. Current MSSP policy for extreme and uncontrollable circumstances mitigates shared losses and adjusts quality assessments when certain criteria are met, but the policy does not adjust benchmarks or performance year expenditures. NAACOS will advocate for these types of adjustments to ensure ACOs are not held accountable for a public health crisis of this magnitude.
Welcome New Commercial ACO Member Broward Health ACO Fort Lauderdale, FL
OVERUSE AND TRUST – HIGH VALUE CARE PLANNING GRANT FOR ACOS Delivering the highest value care to all our patients is an aspiration for all of us. The High Value Care planning grant, sponsored by ABIM Foundation and the Robert Wood Johnson Foundation, kicked off on Friday, March 6 with a review of the project goals followed by a robust discussion of high value care culture and a survey tool offered to ACOs as part of the project. The group will re-convene at the next month to further discuss physician and patient engagement, low value care measures and strategies that might support ACOs with project organizers from ABIMF, the MacColl Institute and the Institute for Accountable Care (IAC). The group will also discuss clinical focus areas. For more information on the project, please don’t hesitate to reach out to Jennifer Perloff from IAC at jperloff@institute4ac.org.
MARCH 31 ACO QUALITY REPORTING DEADLINE APPROACHES The ACO quality reporting submission deadline is March 31, 2020. CMS will automatically accept the data entered in the Quality Payment Program (QPP) website as of Tuesday, March 31, 2020, at 8:00 pm ET. This information will be considered your final submission. As a reminder, you must have an appropriate user role associated with your organization with a Health Care Quality Information System (HCQIS) Access Roles and Profile (HARP) User ID and password to complete the submission process.
Additionally, for ACOs subject to MIPS, the deadline for clinician practices and individual eligible clinicians (ECs) to submit their Promoting Interoperability (PI) data is also Tuesday, March 31, 2020, at 8:00 pm ET. Practices and clinicians will report and attest to PI data also via the Quality Payment Program (QPP) website. Hospitals and Medicaid Eligible Professionals (EPs) also report PI data under separate hospital PI rules and requirements; the acute hospital, Critical Access Hospital and Medicaid PI reporting deadline to submit is March 2, 2020. More information on the hospital and Medicaid PI requirements are available.
NAACOS SENDS LETTER TO CMS ON QPP ISSUES FOR ACOS NAACOS recently sent a letter to CMS urging the agency to take action on a number of key issues for ACOs related to QPP. The letter urges CMS to:
Revise QP thresholds, using flexibility given to the agency in making patient count thresholds,
Align QP calculations with ACO definitions to ensure more transparency and understanding in how the QP calculations are conducted, and
Base Advanced APM bonuses on aggregate allowed amounts and pay bonuses by June 30.
NAACOS OVERVIEW OF THE PROPOSED 2020 CJR RULE NOW AVAILABLE CMS recently released a proposed rule revising certain aspects of the Comprehensive Care for Joint Replacement (CJR) Model and extending the model for an additional three years, through December 31, 2023, for certain participants. NAACOS has developed an overview of the proposed rule outlining key changes to the model proposed by CMS. CMS is accepting comments on the proposals through April 24, 2020, and comments can be submitted via the regulations.gov website.
Welcome New Business Partners
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Karuna Health Karuna partners with ACOs to make sure that there’s “no wrong door” for high-risk members seeking care and to guide them to the right place at the right time. We become a core part of an organization’s care management workflows, but augment them with automation, family caregiver engagement, and multiple communication channels including SMS. meetkaruna.com
NAACOS APPLAUDS REINTRODUCTION OF BILL TO MODERNIZE SUBSTANCE USE DISORDER PRIVACY LAW NAACOS is supportive of a reintroduced bill aimed at making it easier to share the medical records of people with substance use disorder. The revised Protecting Jessica Grubb’s Legacy Act (S. 1012) would require initial written consent from the patient before records can be shared more broadly. It also allows patients to opt-out in the future should they change their minds. Changes should draw broader support to update privacy protections for patients with substance use disorders. In addition to a press statement, NAACOS also joined dozens of other healthcare organizations voicing their support for the bill.
We encourage you to write your elected representatives to voice your support for this bill using our Take Action page. It’s important that Congress hear from constituents on this issue and how the current law limits your ability to provided well-coordinated care.
MEDPAC CONTINUES ACO DISCUSSIONS The Medicare Payment Advisory Commission (MedPAC) continued its work on ACO-related issues during its recent March meeting, once again backing National Provider Identifier (NPI) – level attribution in MSSP. This time, MedPAC commissioners considered a draft recommendation, which is likely to be in the panel’s June report to Congress. This is a policy change NAACOS has repeatedly advocated for in the past. NPI-level attribution would solve, in MedPAC’s eyes, several problems around adverse patient selection. It’s important to note that while MedPAC plays a prominent role in health policy by making recommendations to Congress, those recommendations are not binding, and Congress or the Administration must take action to enact policy changes.
Also at its March meeting, MedPAC discussed the role of specialists in ACOs and other alternative payment models (APMs). This will be another area of focus for the commission going forward. Although very preliminary, commissioners are looking at ways to engage specialists with the episodic bundles while keeping an eye on total-cost-of-care models. Addressing the overlap of various APMs continues to be a policy priority for NAACOS.
AFFORDABLE CARE ACT CASE GOES TO THE U.S. SUPREME COURT The U.S Supreme Court announced that it will hear arguments in the Texas v. Azar case this fall. This is earlier than some court watchers had predicted when the case went up for appeal. The case will certainly be used as a talking point during this year’s election because it threatens to invalidate the entire Affordable Care Act (ACA). NAACOS has previously reported on news regarding this case and will continue to closely follow developments.
CMS PUBLISHES PARTICPANTS OF NEW AMBULANCE ALTERNATIVE PAYMENT MODEL The Center for Medicare & Medicaid Innovation announced the ambulance providers selected to participate in the new Emergency Triage, Treat, and Transport (ET3) Model, which tests paying ambulance services for treating patients at a scene, transporting to non-emergency department, or treating via telemedicine. The list includes applicants from 36 states and the District of Columbia. CMS plans to publish the final list of participants after the model officially launches later this year. While only ambulance service providers are eligible to participate, ACOs could coordinate with ambulance providers in their markets on how to best direct ACO patients to the most clinically appropriate, high-quality and cost-effective setting.
