clinician reported- barriers to joining an apmcosehc.org/v3/documents/mcgann.pdf · 11 accountable...
TRANSCRIPT
1 There may be a more recent version of the Reference Guide on the TCPi Portal. Please refer to most updated version of the guide before disseminating information.
• Not prepared for, or tolerant of, negative risk
• Limited access to APMs based on specialty or geographic options
• Clinicians joining Medicare AAPMs would have to dis-enroll from TCPI, causing a disincentive to join an APM until later in the TCPI model test
Clinician reported- Barriers to Joining an APM
The CMS Value Statement
CMMI References
• CMS Innovation Center (CMMI): https://innovation.cms.gov
• Look under 2019 Milestones & Updates for a “fact sheet” on Physician-Focused Payment Models (pfpms).
• Posted on 4 Jan 2019: https://innovation.cms.gov/pfpms
• In the “additional information” section, there is a “Fact Sheet” in pdf format called: “Value Considerations for Model Development & Testing Fact Sheet”
5 There may be a more recent version of the Reference Guide on the TCPi Portal. Please refer to most updated version of the guide before disseminating information.
HCP LAN APM Measurement Effort
All-Payer Combination Option under QPP
• See the Quality Payment Program Website: qpp.cms.gov
• Look under the “APM Tab”
7 There may be a more recent version of the Reference Guide on the TCPi Portal. Please refer to most updated version of the guide before disseminating information.
From our last time together (2016)
Appendix
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Weaknesses of Fee for Service Payment
Excessive use of
low-value services
Insufficient
incentives to
improve quality
of care
Poor coordination
of care
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Payment Taxonomy Framework
Category 1:
Fee for Service
-No Link to
Quality
Category 2:
Fee for Service -
Link to Quality
Category 3:
Alternative Payment Models
Built on Fee-for-Service
Architecture
Category 4:
Population-Based
Payment
Med
icare
FFS
Limited in
Medicare fee-
for-service
Majority of
Medicare
payments now
are linked to
quality
Hospital value-based
purchasing
Physician Value-Based
Modifier
Readmissions/Hospital
Acquired Condition
Reduction Program
Accountable care organizations
Medical homes
Bundled payments
Comprehensive primary care
initiative
Comprehensive ESRD
Medicare-Medicaid Financial
Alignment Initiative Fee-For-
Service Model
Eligible Pioneer
accountable care
organizations in years 3-5
Payment Taxonomy Framework
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We need to learn our way
into a better system,
together.
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Accountable Health Communities Model--AHCM
• Announced by HHS on 5 January 2016
• Can find it on www.hhs.gov in “News” section
• $157M in grant awards for up to 44 Programs
• Focused on addressing the social needs of
patients, tests if we address: • Housing instability
• Food insecurity
• Transportation limitations
• Interpersonal violence
• Do we improve the quality and effectiveness of the Medicare
and Medicaid Programs?
https://innovation.cms.gov/initiatives/ahcm
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Accountable Health Communities Model--AHCM
“We recognize that keeping people healthy is about more than what
happens inside a doctor’s office, and that’s why, for the first time, we
are testing whether screening patients for health-related social needs
and connecting them to local community resources like housing and
transportation to the doctor will ultimately improve their health and
reduce cost to taxpayers.”
Clinical Practice Improvement Activities
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The Secretary is required to specify clinical practice improvement activities. Subcategories of activities are also specified in the statute, some of which are:
Secretary shall solicit suggestions from stakeholders to identify activities. Sec. retains discretion. Secretary shall give consideration to practices <15 EPs, rural practices, & EPs in under served areas.
Other MIPS/APM Provisions
Additional MIPS/APM provisions require the Secretary to: • Engage the physician and eligible professional
community to develop care episode groups, patient condition groups, and patient relationship categories.
• Provide technical assistance to small practices in rural areas, health professional shortage areas, and medically underserved areas with respect to the MIPS performance categories and to help practices transition to APMs.
References
• MACRA Legislation: https://www.govtrack.us/congress/bills/114/hr2
• Congressional Research Service Review of MACRA: https://www.fas.org/sgp/crs/misc/R43962.pdf
• MACRA and MIPS on CMS.gov:
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html
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January 12, 2016
APM Framework White Paper
For Public Release
A Comment Summary is also accessible
The final APM Framework White Paper may be viewed at:
www.hcp-lan.org
The final version of the White Paper reflects LAN participant comments, as appropriate, and is a much
stronger document because of them.
Final APM Framework White Paper
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For Public Release
Changing providers’ financial incentives is not sufficient to achieve person-centered care, so it will be essential to empower patients to be partners in health care transformation.
The goal is to shift U.S. health care spending significantly towards population-based payments.
Value-based incentives should ideally reach the providers who deliver care.
Payment models that do not take quality into account will be classified within the appropriate category and marked with an "N" to indicate "No Quality" and will not count as progress toward payment reform.
Value-based incentives should be intense enough to motivate providers to invest in and adopt new approaches to care delivery.
APMs will be classified according to the dominant form of payment, when more than one type of payment is used.
Centers of excellence, accountable care organizations, and patient-centered medical homes are examples in the Framework, rather than categories, because they are delivery systems that can be applied to and supported by a variety of payment models..
APM Framework Summary of Key Principles
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