Medical groups urge CMS to count Medicare Advantage under MACRA by 2019

Ten U.S. medical groups have asked the Centers for Medicare and Medicaid Services (CMS) to treat Medicare Advantage (MA) plans as an alternative payment model (APM) under MACRA beginning in 2019, two years ahead of the current schedule.

Medicare Advantage plans are offered by private companies preapproved by Medicare, which pays these organizations to cover an enrolled patient’s Medicare benefits. MA plans include health maintenance organization (HMO) plans, preferred provider organization (PPO) plans, and medical savings account (MSA) plans.

MA plans have grown increasingly popular over the years, with 31 percent of all Medicare beneficiaries, or 17.6 million people, enrolled in MA plans in 2016, more than triple the 5.3 million enrolled in 2004.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established the Quality Payment Program (QPP), which allows providers to shift all or part of their Medicare payment to an Advanced APM and enables those meeting minimum revenue requirements to collect a 5 percent bonus from 2019 through 2024. MA plans, however, aren’t scheduled to be eligible for QPP bonuses until 2021.

In a May 31 letter to CMS Administrator Seema Verma, the groups – which include the American College of Surgeons (ACS) and the American Medical Association (AMA) – lauded CMS’s “push toward a new system in which quality and cost are valued over volume of services provided.”

“The Medicare Advantage (MA) program has been a key component in those efforts and inspired many innovations in care that benefit patients and the Medicare program,” the groups wrote. “With the onset of new payment models such as Alternative Payment Models (APMs), we want to ensure that MA continues to play a pivotal role in the transformation of patient care in this country.”

Noting that only Medicare Fee for Service revenue and patients are eligible for the 2019 and 2020 payment adjustment years, the medical groups urged Verma to alter CMS regulations “to allow clinicians’ contracts with MA plans that meet the risk, quality and certified electronic health information technology requirements to be included under the beneficiary count test for the 5 percent Advanced APM bonus in 2019 and 2020.”

In addition to the ACS and AMA, the letter to Verma was signed by Premier healthcare alliance, AMGA, the American Osteopathic Association, America’s Essential Hospitals, the Healthcare Leadership Council, the Healthcare Transformation Task Force, the Medical Group Management Association, and the National Association of ACOs.

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