10 organizations urge Price to give doctors MACRA credit for Medicare Advantage advanced APMs

Male doctor in white lab coat
Groups hope advanced APMs will be expanded under MACRA.

Ten organizations are asking HHS Secretary Tom Price to expand the options under MACRA for physicians and physician groups to include advanced alternative payment models (APMs) that are part of Medicare Advantage plans.

In a letter sent to Price on Friday, the groups, which represent both physicians and payers, called on Price to accelerate the movement from volume to value-based payment by adopting equitable incentives for physicians taking risk in Medicare Advantage (MA) contracts with health plans.

The insurance industry was not pleased that the final rule released last October that implemented the new physician payment system under the Medicare Access and CHIP Reauthorization Act (MACRA) did not allow Medicare Advantage plans to qualify as an advanced APM for several years.

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The Centers for Medicare & Medicaid Services determined that MACRA will include traditional Medicare, not Medicare Advantage. But starting in 2021, Medicare Advantage plans could qualify under the All-Payer Combination Option.

The groups asked Price to speed up that timeline and give physicians and physician groups credit for the advanced APM arrangements they conduct in Medicare Advantage.

“Recognizing the advantages of alternative payment models in MA, we call on the administration to level the playing field and afford risk arrangements in MA the same credit under MACRA as risk arrangements in traditional Medicare,” the letter said.

RELATED: Doctors look to HHS Secretary Tom Price to provide MACRA relief; proposed Medicare rule in the works

Many doctors are hoping Price will make the Medicare payment system easier for them when he releases a proposed Medicare rule, expected in the coming weeks.

Paul Cotton, director of federal affairs, public policy and communications at NCQA, one of the groups that signed the letter, told FiercePracticeManagement the goal is to get more physicians out of MACRA’s other track, the Merit-Based Incentive Payment System, and into advanced APMs.

“Providing APM credits for doctors participating in advanced payment models under Medicare Advantage will encourage value-based arrangements and advance the nationwide movement to reward clinicians for the value of the care they provide, rather than the volume of care,” said NCQA President Margaret E. O’Kane.

The letter describes evidence that shows APMs between health plans and physicians in Medicare Advantage deliver higher quality care at lower cost than fee-for-service payment models in Medicare Advantage.

The letter cites a recent study, published in the American Journal of Managed Care, that showed that patients in capitated Medicare Advantage had a 6% higher survival rate and were 11% less likely to visit the emergency room and 12% less likely to have an inpatient admission.

Along with the NCQA, other groups that signed the letter were: CAPG, Healthcare Leadership Council, America’s Health Insurance Plans, Health Care Transformation Task Force, Pacific Business Group on Health, Direct Primary Care, Alliance of Community Health Plans, National Coalition on Health Care and the Blue Cross Blue Shield Association.