On August 12, the Alexandria, Virginia-based AMGA (American Medical Group Association) sent a letter to Seema Verma, Administrator of the Centers for Medicare & Medicaid Services (CMS), urging her to consider a range of reforms that the association believes could help physicians and physician groups to advance more smoothly into value-based payment and care delivery.
As a press release published to its website stated, “AMGA today recommended that the Centers for Medicare & Medicaid Services (CMS) reform a number of regulations and policies to ensure they support providers’ ability to deliver care in value-based models. In response to CMS’ Request for Information [RFI] on reducing administrative burden, AGMA offered detailed policy recommendations designed to reduce Medicare programs’ regulatory complexity so our member providers are better able to focus on providing the best possible patient care.”
The press release quoted AMGA president and CEO Jerry Penso, M.D., who stated that “Our members are treating patients through delivery models that hold them accountable for the cost and quality of the care they provide. These models by design do not contain the same misaligned incentives seen in the fee-for-service environment, and Medicare’s rules and policies need to recognize and account for this difference,” Dr. Penso said in his statement.
The press release went on to note that “AMGA recommended that CMS revise regulations and policies in the Medicare Shared Savings Program (MSSP) and waive Appropriate Use Criteria (AUC) for providers in value-based models. For example, payment waivers in the MSSP should be available for providers at all levels of risk, as restricting them based on the level of risk creates different rules that do not prepare providers for the transition into risk-bearing models. AMGA also recommended several reforms to documentation and reporting requirements. More specifically, some documentation requirements for ordering Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) do not reflect care delivery and workflow processes and should be revised.”
The letter, sent to Administrator Verma under Dr. Penso’s signature, stated that “AMGA supports policies that reduce the Medicare programs’ regulatory complexity so our member providers are better able to focus on providing the best possible patient care, rather than divert their attention toward regulatory compliance activities that do not improve the patient experience. Our overarching legislative and regulatory goals revolve around advancing the shift from fee-for-service (FFS) payments to reimbursement based on the value of the care provided. AMGA believes regulations should be designed and implemented so that providers are encouraged to innovate,” Dr. Penso stated in the letter.
He went on to say that “Value-based models, such as Accountable Care Organizations (ACOs) and other Alternative Payment Models (APMs), are designed to remove the misaligned financial incentives that grew out of the FFS system, while also entrusting providers with the responsibility for the health of not just individual patients, but an assigned patient population. The regulatory framework governing these models of care delivery should reflect this key difference,” he wrote.
The main recommendations in the letter are the following:
Ø Synchronize Rules and Regulations Across Medicare’s Accountable Care Organization Programs: Payment waivers should be available for all levels within the Medicare Shared Savings Program (MSSP). Restricting these tools based on the level of risk is counterproductive to the goals of the program and hinders the ability of providers to develop care delivery models.
Ø Encourage Use of Preferred Provider Lists: To improve the discharge process and foster care coordination, providers in value-based models of care should have the ability to develop and use preferred provider lists to inform patients of their options for post-acute care.
Ø Waive Appropriate Use Criteria for Value-Based Models: As the incentives underlying the rationale behind the Appropriate Use Criteria (AUC) requirement are not present in value-based models of care, the requirement to consult clinical decision-support mechanisms should be lifted for providers who order advanced diagnostic imaging as part of a value-based model.
Ø Streamline Quality Measurement Reporting: CMS should continue its work under the Meaningful Measures initiative to harmonize and scale down the amount of quality measures for all providers in value-based arrangements. Using a standard set of value measures will help reduce the variation in the measures that are reported and help eliminate unnecessary confusion and administrative burden. In fact, in 2018 AMGA’s Board of Directors endorsed a set of 14 quality measures we believe are clinically meaningful to patients and providers.
Ø Reduce Documentation Requirements for DMEPOS: CMS should evaluate its documentation requirements for ordering Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS), as they do not reflect care delivery and workflow processes. Signature requirements should account for how items are prescribed and dispensed. The blanket requirement for a physician signature does reflect how care is delivered.
Ø Evaluate the Need for Advance Beneficiary Notice of Noncoverage: CMS should update its estimates of the burden associated with the Advance Beneficiary Notice (ABN) requirement and work with the provider community to determine if every test or procedure should be subject to the written notification.
Ø Compensate Providers for Translation Services: CMS should clearly explain provider obligations for providing translation services and ensure providers are appropriately reimbursed for providing such services.
Ø Remove Requirement for Physician Signature for Home Health Services: CMS should allow Nurse Practitioners (NPs) and Physician Assistants (PAs) to certify home health services without the need of a physician’s signature.
As AMGA notes on its website, “Representing multispecialty medical groups and integrated systems of care, we advocate, educate, innovate, and empower our members to deliver the next level of high--performance health,” representing more than 175,000 physicians, “who are delivering care to one in three Americans.”
