In a letter to lawmakers, the Alexandria, Va.-based AMGA emphasized the need for Congress to address a number of policy changes to support the healthcare industry’s transition to value-based care.
Specifically, AMGA urged Congress to enact key reforms so that providers have access to administrative claims data, patients with chronic disease benefit from care management, and the Medicare physician payment system supports providers’ investments in the value-based care delivery systems.
“AMGA members need the proper tools for the shift to value to succeed,” AMGA President and CEO Jerry Penso, M.D., said in a statement. “Congress has an opportunity to implement these critical reforms and build on its past work to support the shift to value-based care.”
AMGA represents more than 450 multispecialty medical groups and integrated delivery systems, representing approximately 175,000 physicians. In its letter to key lawmakers—starting with Speaker Nancy Pelosi—the association outlined the legislative changes that Congress should enact to create a pathway to value. Some of those core details include:
Access to claims data
AMGA said it regularly surveys its membership on what obstacles and barriers prevent them from transitioning into value-based models. The members consistently cite access to administrative claims data as one of the most significant impediments to taking on financial risk for their patient populations. To overcome this problem, AMGA noted that it worked closely with the Senate Health, Education, Labor and Pensions (HELP) Committee on legislative language that would require commercial plans to share claims data. In the letter, the group encouraged Congress to ensure this provision is included in an upcoming healthcare legislative package.
“Knowing who provided care, what was done, when, and where a treatment was provided is critical for any value-based model to succeed,” Penso said. “Without timely access to claims data, our providers simply won’t have a complete patient history and will be making care decisions with incomplete information. Requiring payers to share claims data with providers is a common sense solution to a problem that has stymied a broader adoption of value-based models of care.”
Chronic care management
AMGA noted that in 2015, Medicare began reimbursing providers for Chronic Care Management (CCM) under a separate, billable code in the Medicare Physician Fee Schedule to support non-face-to-face care management. Under current policy, Medicare beneficiaries who receive these services are subject to a 20 percent coinsurance requirement. However, only 684,000 out of 35 million eligible Medicare beneficiaries with two or more chronic conditions benefitted from CCM services over the first two years of the payment policy, AMGA stated.
As such, the association recommended Congress remove the coinsurance payment requirement, which it believes will encourage the code’s use and support chronic care management and improve patient health. AMGA asserted that Congress should enact the Chronic Care Management Improvement Act (H.R. 3436), which would waive Medicare’s CCM code coinsurance requirement.
Physician payment system
According to AMGA, Congress also should require Medicare to implement fully the Medicare Access and CHIP Reauthorization Act (MACRA). As it currently stands, the association contended, the program’s implementation has excluded too many providers from the program, which undermines the ability of those providers who do participate to earn a meaningful payment adjustment.
