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Medicare Payment Reform Ramps Up: How Are We Doing?


It’s been five years since the first Pioneer Medicare Accountable Care Organizations (ACOs) formed, marking the beginning of Medicare payment reform and now one year of the Quality Payment Program (QPP) is up. So, how are we doing? And what can we still learn as it rolls out? The QPP was created to implement Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and if we’ve learned anything in the first year, it is that practices need support to make the changes needed to be successful. I want to highlight three recent articles that have given me pause and can give us direction for our efforts on the path from volume to value.

In the past quarter, a few interesting reports on MACRA and QPP have been published, framing the current status of provider participation, understanding, and potential impact of payment reform. Two reports take a pulse of American physicians. First, the American Academy of Family Physicians (AAFP) self-report Annual Member Survey of 2017 looked at member family physicians and found that 83 percent of reporters take Medicare patients, a record high in the last decade for family docs, yet only 50 percent consider themselves “somewhat-to-very-aware” of QPP/MACRA. And earlier this year, 45 percent reported being “undecided” on their plan to participate in MIPS or APMS.

Next, the American Medical Association (AMA) surveyed 1,000 physicians in a variety of practice sizes and specialties on their current experience with and knowledge of MACRA/QPP. The report is an interesting read (really) and data shows that smaller practices are less ready for payment changes and 41 percent of specialists and generalist have heard of but are not significantly aware of QPP. The survey shows one area that is on target (red arrow) with projections is the number of physicians that know they will be participate in Advanced APMS in 2018, at 22 percent and 15 percent of of surveyed physicians (primary care and specialists, respectively). In the AMA survey group, one-third of specialists and primary care providers are “unsure” if they will report MIPS in 2018. Some of those are the same as the “undecided” family docs represented above.

Finally, this month in JAMA, researchers looked at first year success (describes larger practices) with value-based payment over 899 practices. In the first year of the Centers for Medicare & Medicaid (CMS) value-based payment model practices that served patients with higher social risk (dual eligible Medicaid and Medicare) had lower quality and costs compared to lower risk practices. Practices determined to serve more medically high-risk patients had lower quality and higher costs. This initial assessment raises the concern that penalties will fall to practices with the most complex patients and noted that failure to ”properly register and report data” was the largest factor in penalties.

The volume to value movement has started and by looking at participation, and assessing intended or unintended outcomes, we can learn where support is needed most. To me, these reports show that we need to meet physicians where they are and ensure basics are covered, like registering for QPP submission and data flow. For example, eligible clinicians can submit through the “test” option this year which is a fairly easy way to get credit for MIPS. Then we MUST ensure that practices benefit from this new way to look at their work, help them shift to better practice models and team-based care, work with them to develop medical neighborhoods, and succeed in this new payment landscape.

Specialty societies, CMS, HealthInsight and other Quality Innovation Networks-Quality Improvement Organizations, and larger health systems that are already seeing successes are obligated to support our smaller, less connected practices and partners. Moving from volume to value is a bipartisan effort that is needed to ensure U.S. economic and social success for the next generation. That means we need all hands on deck to make this shift successful.

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