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Value-Based Care is Quietly Transforming Medicine

Courtesy Florida Medical Magazine

While the debate over national health care reform has understandably generated big headlines, ongoing systemic changes in the health care delivery system are quietly making an impact on how physicians practice medicine. Continued adoption of value-based payment models and MACRA implementation are affecting practices large and small, and the impact is all but certain to grow.

ACOs Proliferate

Recent reports indicate that accountable care organizations (ACOs) are still multiplying across the country. According to a report from Leavitt Partners, the total number of ACOs grew from 731 in the first quarter of 2015 to 923 in the first quarter of 2017. These include ACOs developed by Medicare, Medicaid and commercial insurers. In addition, the total number of ACO contracts grew from 1,050 to 1,366 over the same period1. ACO contracts now cover an estimated 32.4 million lives, or roughly 10 percent of the U.S. population.

Florida is home to numerous ACOs, including many physician-led ACOs. CMS' database identifies 49 MSSP ACOs that include Florida in their service area, including several ACOs located in the Orlando area, the Tampa Bay area, and in South Florida. Commercial insurers, including Florida Blue, have also established ACOs throughout the state.

Regional Data - Dispersion of Medicare ACOs Across the U.S.

ACOs and Assigned Beneficiaries (Note: An ACO may be in multiple regions.)

Region

ACOs

Assigned Beneficiaries

% of Region's Medicare Population

1. Boston (CT, ME, MA, NH, RI, VT)

40

698,666

24.6%

2. New York (NJ, NY, PR, VI)

64

907,706

15.7%

3. Philadelphia (DE, DC, MD, PA, VA, WV)

63

1,010,188

17.7%

4. Atlanta (AL, FL, GA, KY, MS, NC, SC, TN)

135

1,757,324

14.2%

5. Chicago (IL, IN, MI, MN, OH, WI)

1000

1,639,093

17.2%

6. Dallas (AR, LA, NM, OK, TX)

71

855,547

13.5%

7. Kansas City (IA, KS, MO, NE)

41

509,839

19.6%

8. Denver (CO, MT, ND, SD, UT, WY)

20

218,083

12.2%

9. San Francisco (AZ, CA, HI, NV)

43

566,084

7.3%

10. Seattle (AK, ID, OR, WA)

9

147,852

6.1%

Courtesy: CMS

And although Medicare ACOs tend to dominate the press, the majority of ACOs and the majority of patients in ACOs belong to commercial insurance plans. Clearly, commercial insurers aren't planning to back away from their commitment to payment reform.

Number of lives covered by ACOs (in millions)

Number of lives covered by ACOs (in millions)

Physicians Lead Most Medicare ACOs

According to a recent report from CMS, more than half of Medicare Shared Savings Program (MSSP) ACOs are composed solely of networks of individual practices or group practices. In other words, substantial numbers of physician practices appear confident that they can operate an ACO without partnering with a hospital.

Reported Composition of Medicare ACOs

Multiple responses may apply to an ACO.

ACOs

Percent

Networks of Individual Practices

267

56%

Group Practices

173

36%

Hospital/Professional Partnerships

181

38%

Hospital employing ACO professionals

152

32%

Federally Qualified Health Center

65

14%

Rural Health Clinic

71

15%

Critical Access Hospital

55

11%

Courtesy: CMS

Experts Still Debate the Benefits of Accountable Care

Despite the continued growth of MSSP ACOs, researchers are still debating the true costs and benefits of the program. Whether ACOs are truly saving money, and how those savings should be measured, are two important topics of ongoing research. This debate is important to the future of value-based health care. Carefully structuring APMs to encourage provider participation while delivering benefits to the overall health care system may be one of the greatest challenges CMS faces in implementing MACRA.

Other Medicare APMs Are Gaining Ground

According to Leavitt Partners, there are now 2,891 medical homes participating in the Comprehensive Primary Care Plus (CPC+) model, 190 Oncology Care Models, 792 participants in the Comprehensive Care for Joint Replacement program, and 27 Comprehensive ESRD Care Models. The FMA believes CMS must go further in making APMs and Advanced APMs more accessible to physicians. While these statistics point to progress at the national level, there are still far too many physicians who have no realistic option to participate in an APM or Advanced APM in their region. For instance, despite high participation figures, the CPC+ program is currently unavailable in Florida, thereby limiting the potential for physicians in this state to qualify for a Medicare payment bonus in 2019.

The Implementation of MACRA Continues

As the FMA reported in June, CMS issued a draft regulation for the second year of MACRA's Quality Payment Program (QPP), with the comment period ending on Aug. 27, 2017. CMS proposed to further raise the low-volume threshold, thereby exempting more physicians from MIPS in the second year of the QPP. However, CMS also proposed to increase the performance threshold for physicians still subject to MIPS. The proposal included numerous other changes, such as the implementation of virtual groups and increased scoring flexibility for small practices. The FMA has evaluated details of the 1,058-page rule and will advocate for Florida's physicians as we continue monitoring CMS' proposal.

We're At Your Service

If you are an FMA member whose practice participates in an ACO or other APM, we are available to support you. The FMA is developing a broad range of solutions to help our members take part in new payment models, and we can connect you with physician leaders who have extensive experience navigating the value-based landscape. Our experts have answers to your questions about MIPS and other complex payment topics as well. Simply contact the FMA at membership@FLmedical.org or (800) 762-0233.

Article reprinted from Florida Medical Magazine with permission from the Florida Medical Association.



 
 
 
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