4 steps CMS should take to support value-based care in independent physician practices

Leaders in the movement to value-based care say the government can better support independent physician practices and called for reforms to programs, including accountable care organizations and Medicare Advantage.

In a letter sent yesterday to Seema Verma, administrator of the Centers for Medicare & Medicaid Services, leaders from groups representing family and primary care doctors and three value-based care providers outlined four steps the agency should take.

The letter, signed by the Medical Group Management Association, the American Academy of Family Physicians, the California Association of Physician Groups, and the Texas Medical Association, along with Iora Health, Aledade and ChenMed, encouraged CMS to expand opportunities for physicians and physician-led groups to take financial responsibility for their patients.

“Physicians—especially independent physician practices—are the lynch pin of our nation’s healthcare system. They have repeatedly demonstrated their superior ability to generate positive results in value-based care arrangements, both in improved health outcomes and reduced costs. They are the most powerful tool we have to foster an affordable, accessible system that puts patients first,” the groups wrote.

They asked CMS to take four steps:

1. Prioritize physician-led advanced alternative payment models, including physician-led ACOs and other approaches, to achieve improved outcomes for patients, great value and the preservation of independent clinical practice.

2. Establish a level playing field within local markets, promoting patient choice and competition. That can happen through policies that create payment parity across practice settings and by prohibiting anticompetitive abuses of market power, such as data blocking and physician no-compete requirements, they said.

3. Reinject competition into Medicare Advantage markets by lowering barriers to entry by physician-led groups.

4. Support consumer-directed care through models that encourage beneficiaries to participate in their own healthcare decision-making, and to be rewarded for doing so. For instance, CMS could empower primary care physicians who hold financial up and downside risk to waive/reimburse patient cost shares for medical services they recommend and allow for the creation of provider-designed and funded behavioral incentive programs where patients can earn rewards.

The letter comes at a time when CMS is hearing increasing concerns about the effectiveness of value-based programs and there are fewer independent practices. For instance, the debate over the value of the new Medicare payment program, the Merit-Based Incentive Payment System (MIPS), has gained steam in recent months. The Medicare Payment Advisory Commission, which advises Congress on issues related to Medicare, is considering a recommendation to replace MIPS.

Two recent studies have raised concerns about the future success of MIPS. Researchers found Medicare’s Value-Based Payment Modifier Program, the predecessor of MIPS, failed to meet its goals and likely exacerbated disparities in healthcare delivery. A separate study released this week found that almost 30% of practices took a financial penalty that cut their Medicare revenue rather than participate in the program.