Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

Newly Launched MACRA Initiative Aims to Support Providers

The MACRA and Risk Initiative aims to help AMGA members prepare for MACRA, adapt to risk-based payment systems and move away from volume-based care.

By Catherine Sampson

- On May 25, American Medical Group Association (AMGA) launched a resource to help its members prepare for MACRA implementation as well as all risk-based payment systems.

The American Medical Group Association launched the MACRA and Risk Initiative as a way to help providers prepare for MACRA and take on more risk.

“We are making it our priority to ensure our members have the tools necessary to meet the challenge of new and rapidly approaching payment models,” said President and CEO Donald Fisherin a public statement.

The MACRA and Risk Initiative leverages AMGA’s expertise in providing advocacy and resources to help its members move away from volume-based care and toward value-based care.

“Most providers have little experience operating in a risk environment. For that matter, few payers have extensive experience sharing risk with providers,” AMGA said previously in public remarks on MACRA. As a result, providers need tools to help them adapt to the value-based care environment.

The initiative helps AMGA members understand various aspects of MACRA, such as its two pathways for taking on risk in the Medicare program. These pathways are Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). The initiative provides information on how MACRA legislation also allows healthcare organizations to take on more risk for the quality and efficiency of the care that they give patients.

When MACRA was signed into a law last year, it ended a reimbursement formula known as the Sustainable Growth Rate as well as other payment incentive programs. In their place, MACRA established two payment incentive schemes for providers to choose from: MIPS and APMs. MIPS makes positive or negative adjustments to a physician’s payment based on his or her performance.

The APM program, on the other hand, awards a fixed five-percent bonus through 2024. After that time period, it will provide higher annual payment updates. Qualifying for the APM incentive track may be difficult for some providers.

Also, in 2021, a new all-payer Advanced APM option will be available. Providers in APM contracts with other payers will be able to participate in the Advanced APM incentive. “In order to determine whether clinicians met the requirements for the Advanced APM track, all clinicians will report through MIPS in the first year,” CMS said.

Under the MACRA and Risk Initiative, AMGA specifically provides peer-to-peer learning by having educational sessions led by AMGA members who have experience obtaining greater levels of risk. The association also provides various types of resources to help healthcare provider organizations understand MACRA in a more in-depth way. Some of these resources include: best practices summaries, educational meetings and webinars, infographics, PowerPoint presentations, workshops and consulting services.

On AMGA’s website, there is background information on MACRA. AMGA also created a glossary of key policy acronyms. The website also includes links to AMGA policy briefs on MACRA and risk readiness.  One of the infographics on the site provides a summary of a survey on providers risk readiness.

In the best practices section of the website that AMGA made for its initiative, there is a report titled “Medicare Advantage 101: How it’s Different, Tips for Getting Started (and Paid)”, which is free to AMGA members. The best practices portion of the website also includes reports on population health management, patient satisfaction and engagement and physician compensation and engagement.

Additionally, AMGA provides high-performing health systems with an assessment program. This program includes webinars and workshops. For this program, AMGA specifically looks at participation rates and provides Web-based assessment based on recent Dartmouth and industry research.  At the end of the program, AMGA provides participants with a comprehensive report and executive summary.  

The assessment program is supposed to help health system leaders to gauge variation in perceptions of their organization’s ability to achieve value-based care, prioritize strategies for transitioning to value-based payment and define improvement targets. Additionally, the program aims to establish a culture of “continuous learning,” AMGA said.

“Our initiative provides the opportunity for leaders of medical groups and integrated systems of care to learn from each other and share knowledge about what is working in preparing for MACRA and risk-based payment systems,” said Chester Speed, vice president of AMGA.

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