Final Rule concessions under MACRA may just delay implementation of new payment model, and together CMS and Vermont create single, state-wide ACO.
Welcome to Practice Rounds, our new weekly column exploring what's being covered in the larger world of healthcare.
CMS has announced a co-venture with the State of Vermont called the Vermont All-Payer Accountable Care Organization (ACO) Model, according to an agency press release. The statewide ACO aims to enroll all major state payers to include Medicare, Medicaid, and commercial health plans, to jointly incentivize quality patient care and outcomes for the state's medical providers. The new payment model will reimburse all participating providers under the same compensation structure. CMS is providing a $9.million grant to help Vermont physicians with care coordination and collaboration with community providers, and has extended Vermont's Medicaid Demonstration project for five years, so that Medicaid can be a full partner in the All-Payer ACO program. The Vermont Medicare ACO Initiative (part of the larger All-Payer ACO) will qualify as an Advanced Alternative Payment Model under the Medicare Access and CHIP Re-Authorization Act (MACRA).
Amid great anticipation, CMS has released its final rule for MACRA. At 2,400 pages, it is complex and not well-understood, especially by smaller practices, reports Medical Economics. While the legislation has softened first-year reporting requirements, giving physicians the option of "picking their own path" to compliance, there are still significant hurdles for smaller entities. Family physician John Meigs, Jr., president of the American Association of Family Physicians, feels data reporting will challenge small practices and regrets the delayed implementation of "virtual groups" that would allow them to join forces and combine data. Another sticking point is the technology specifications, which will necessitate practices use a 2015-certified EHR for reporting data starting in 2018.
Humana has just released the year-end performance results for its Medicare Advantage value-based reimbursement model, which indicates continued improvement in patient health, quality care, and cost controls, according to a company press release. Humana compared member data for Medicare Advantage patients who were treated by providers enrolled in value-based reimbursement programs, and those operating under standard reimbursement agreements. Key findings from 2015 data are:
• Providers in value-based agreements scored 19 percent higher on Healthcare Effectiveness Data and Information Set (HEDIS) than peers in traditional reimbursement agreements;
• Medicare Advantage members treated under value-based arrangements had 6 percent fewer emergency room visits than patients treated under traditional reimbursement agreements; and
• Humana had 20 percent lower overall costs for members treated under value-based arrangements vs. those treated in traditional fee-for-service Medicare programs.
Quote of the Week:
"While most physicians do an excellent job of focusing on patients and leaving personal opinion and biases aside, this neutrality can be hard to completely achieve. In this season of intense political debate and a particularly passionate upcoming presidential election, physicians may find it even harder to refrain from sharing their political opinions with others."
Ericka L. Adler, healthcare attorney