MGMA Voices Displeasure With CMS’ Talk of Mandated APMs

Oct. 22, 2020
The group and its members responded to recent comments from CMS senior leadership about mandatory participation in value-based care initiatives

More than three-fourths (76 percent) of healthcare leaders voiced opposition to the government requiring participation in alternative payment models (APMs), according to a new MGMA Stat Poll.

The research, conducted by the Colorado-based Medical Group Management Association, was conducted this month and included more than 800 applicable responses. Healthcare leaders were asked, “Should the government mandate participation in Medicare alternative payment models?” Only 10 percent responded “yes,” showing that the vast majority (76 percent) of respondents prefer flexibility and choice in value-based payment reform. The other 14 percent responded “unsure.”

The Centers for Medicare & Medicaid Services (CMS), through its Innovation Center (CMMI), is charged with testing APMs, yet according to MGMA, the agency “has been frustratingly slow in producing new options. In an effort to spur innovation, CMS Administrator Seema Verma recently made concerning remarks that CMS will implement more mandatory models in the future.

What MGMA is referring to is a recent virtual presentation from Verma on the state of value-based care and CMMI, in which the agency head said, according to a report in Skilled Nursing News, “The bottom line is CMMI models are losing money, generating large losses and a weak return on investment for taxpayers. The center stands in need of a course correction in model design and portfolio selection if value-based care is to advance.” Verma added, per that report, “Unfortunately, the results are deeply concerning. To date, only five models have shown statistically significant savings, and of these five, only three have been expanded on a national scale. Just a handful have seen significant improvements on quality metrics.”

She further emphasized that that mandatory participation  will be vital to success, specifically calling out increased risk requirements for accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) as a factor in its recent savings figures. Verma attested, in the report, that models need to incorporate design elements that require participants to have “skin in the game,” and that downside-risk models perform better than upside-only ones. CMMI director Brad Smith agreed with Verma, noting, “When necessary, we will also move forward selectively with mandatory models.”

MGMA said while it continues to strongly support efforts to improve value-based payment, it “does not agree with mandating participation in payment models that are untested and lack evidentiary support.” The association stated, “Joining an APM is an important business decision that should be made by a group practice, rather than a mandate by the government. There is no single approach to APMs that will work for all practices or specialties, which is why multiple, voluntary models are needed so that providers can test new designs for care and payment delivery.”

Ultimately, moving forward, Medicare leadership has stated it will require more physician groups to participate in new payment models that will feature greater financial risk and fewer opportunities for financial reward. Rather than offering financial incentives for model participants, CMS states it favors offering regulatory flexibility as a benefit.

MGMA called Verma’s and Smith’s remarks “disappointing, and fail to recognize group practices that have voluntarily participated in APMs, improved care delivery, implemented changes to reduce costs, and contributed to efforts to understand what is working. Not only is mandatory participation a significant concern, the new direction outlined by Medicare leadership conveys a narrow focus on savings to Medicare.”

According to MGMA, “Payment reform must include adequate reimbursement rates, incentives, and supports, and must strike an appropriate balance between offering financial incentives for those that achieve model goals and generating savings to the Medicare Trust. Requiring group practices to move into new payment models that lack adequate financial incentives but entail significant downside risk creates an untenable path forward.”

The association added, “Rather than taking a shortcut to boosting numbers by mandating participation in APMs, CMS should focus on continuing to develop new models that meet the needs of a diverse range of practices of varying types, sizes and specialties, which will inherently drive more widespread participation. It is critical that CMS gives providers the choice to participate in an APM because not all group practices will be prepared to make the changes necessary to succeed in new delivery models.”