On Thursday, September 13th, the House Energy & Commerce Subcommittee on Health held a hearing entitled, “Examining Barriers to Expanding Innovative Value-Based Care in Medicare.” This hearing focused on the efforts to transition the Medicare program away from fee-for-service and towards various arrangements designed to promote better and more coordinated health care, but also as a means to provide cost controls in Medicare. Among the issues discussed were promoting ideas away from fee-for-service, improving accountable care organizations (ACOs), implementing ideas borne out the Physician-Focused Payment Model Technical Advisory Committee (PTAC) reviews, and ways to improve alternative payment model (APM) participation via changes to the Stark Law and anti-kickback statute.
ACG supports efforts to promote voluntary participation in APMs, if they make financial sense to individual GI practices and improve care to our patients. ACG does not support, however, any goal of pushing physicians towards APMs simply as the means to implement cost controls in Medicare.
Help ACG advocate for the “Medicare Care Coordination Improvement Act” (S.2051; HR 4206). This legislation seeks to modernize the physician self-referral prohibitions to promote care coordination to facilitate participation in APMs under the Medicare program.
On Thursday, September 6th, HHS Secretary Alex Azar made some interesting remarks during the most recent PTAC meeting. His remarks focused on value-based healthcare. Notably, he mentioned mandatory participation in APM models.
“We need strategies and models that provide better care at a lower price, not just new models for the sake of new models, and not new systems of payment for old systems that aren’t open to real change. In some cases, as I’ve said before, that is going to mean mandatory models from CMMI and other mandatory reforms. Requiring participation can be necessary to determine whether a model really works, but it may also be necessary to meet what we see as an urgent need for reform. But we are not going to be overzealous in determining how these reforms happen. We’re interested in driving the outcome we want, rather than micromanaging how you get there.”
The issue of mandatory participation in APMs has long been on ACG’s radar screen, as policymakers continue efforts to reform Medicare. The College continues to educate policymakers that the goal should be focusing on evidence-based medicine and promoting quality improvement registries in order to collect information and to further improve patient care. The goal should not be forcing payment models upon GI practices that may not be suitable or sustainable for their individual needs.
How can ACG help you navigate the APM waters? Want some practical tips?
The most recent issue of ACG Magazine also includes helpful articles on practice management, and the latest installments add to the growing catalog of useful articles on ACG’s Practice Management Toolbox. Including:
- “Hiring and Keeping the Best Staff: Human Resource Management and Staff Development” by David L. Limauro, MD FACG and Louis J. Wilson, MD FACG
- “Getting to Yes: Five Steps to Negotiating Alternative Payment Model Arrangements” by Ann M. Bittinger, JD
Accessible, relevant, and practical projects to improve your practice.
Gastroenterologists in private practice find themselves working in a time of unprecedented transformation. Pressures are high as they make important management decisions that profoundly affect their business future, their private lives, and their ability to provide care to patients. The ACG Practice Management Committee has a mission to bring practicing colleagues together to explore solutions to overcome management challenges, to improve operations, enhance productivity, and support physician leadership. It was in this spirit that the Practice Management Toolbox was created.
Whitfield L. Knapple, MD, FACG
Chair, ACG Legislative and Public Policy Council