Dear ACG Ohio Member,
Ohio’s Governor’s Office of Health Transformation (OHT) has started an initiative to pay for “value” for commercial and Medicaid services. What does this mean? This has a significant impact on providers and ACG membership. As an initial step, Medicaid and participating commercial plans are launching performance reports for 6 episodes of care. For GI providers in Ohio, the relevant “episodes” are:
-Gastrointestinal (GI) bleed
This covers all Medicaid patients (fee for services as well as Medicaid managed care plans) and four commercial carriers: Aetna, Anthem, Medical Mutual of Ohio, and United Health Care. Together, this represents over 90% of the market.
When will this Begin?
Medicaid: “Wave 1” in 2016 will be for reporting purposes only. In 2017, “Wave 2” begins in 2017 where a retrospective provider will be deemed accountable for potential bonuses or cuts, depending on quality of care. According to the Ohio State Medical Association, the first round of gain-sharing bonuses and cuts may occur in the second quarter of 2018, based on 2017 reported data.
Commercial payers will be contracting separately with “principal accountable providers” or PAPs, with the intent of following similar timelines and methodology as outlined in this document.
What is an “episode” and how will this impact me?
What is ACG doing for me?
ACG does not endorse simply linking reimbursement to quality reporting. However, in the event that state and federal policymakers mandate quality reporting as a condition to payment, it is ACG’s goal to minimize practice management burdens and protect GI reimbursement as much as possible. Thus, Ohio officials agreed with ACG physician representatives that a GI providers’ gain-sharing or cuts should be conditional upon simply participating in a quality improvement registry such as GIQuIC.
These episodes groups are complex and have a high potential for an unfair process that penalizes ACG members in OH. ACG will continue to update you as we continue to engage OH regulators on your behalf.
David G. Mangels, MD, FACG Ashley L. Faulx, MD, FACG
ACG Governor for Southern Ohio ACG Governor for Northern Ohio