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Health Organizations Urge HHS to Recognize MA Providers in MACRA

Laura Joszt
Healthcare organizations have sent a letter to HHS, urging it to count physician participation in Medicare Advantage (MA) plans toward participation criteria for the Advanced Alternative Payment Model track of the Quality Payment Program.
A collection of 11 health groups has sent a letter to Adam Boehler, the director of the Center for Medicare and Medicaid Innovation Center, urging HHS to recognize physician participation in Medicare Advantage (MA) toward participation criteria for the Advanced Alternative Payment (APM) Model track of the Quality Payment Program, implemented under the Medicare Access and CHIP Reauthorization Act (MACRA).

The concern these organizations raise is that, while physician groups must meet a 25% revenue threshold in traditional Medicare to qualify for the Advanced APM track, physicians in areas of the country with heavy MA penetration cannot achieve this threshold, and thus aren’t eligible to be included in the Advanced APM track despite the risk they are already taking on. The organizations are urging HHS to treat risk contracts equally across traditional Medicare and MA.

“If we are truly committed to moving our nation’s delivery system away from volume-based compensation and towards payment for value and high-quality care, we must ensure provider incentives are aligned in both traditional Medicare and MA to incent participation in risk-bearing alternative payment models,” the organizations wrote in the letter, which was copied to HHS Secretary Alex Azar and CMS Administrator Seema Verma.

They added in the letter that 1 in 3 Medicare beneficiaries is now enrolled in an MA plan, but, despite that, providers engaged mostly in MA risk contracts will have to wait 3 more years to get credit for their participation. CMS had announced in November 2017 that it intended to develop a demonstration to allow MA participants to receive credit for financial risk-based arrangements within MA plans. However, this demonstration has not been implemented yet.

The organizations encourage HHS to announce a new MA Advanced APM that would use performance data in 2017 to impact 2019 payments.

“MA plays a significant role in properly aligning provider incentives to move away from fee-for-service toward value-based reimbursements,” the organizations wrote. “If we are truly serious about modernizing our nation’s healthcare delivery system and improving access to quality healthcare services for America’s seniors, providers in MA must have access to the same incentives as their colleagues practicing in traditional Medicare.”

The organizations who signed the letter are Alliance of Community Health Plans, America’s Health Insurance Plans, America’s Physician Groups, BlueCross BlueShield Association, Healthcare Leadership Council, Health Care Transformation Task Force, Medical Group Management Association, National Association of ACOs, National Committee for Quality Assurance, National Coalition on Health Care, and Premier.

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