The work of health policy reform is a marathon, not a sprint. The ACR is encouraged by the forward progress being made in collaboration with the American Medical Association and other physician-led organizations within the Healthcare Leaders for Accountable Innovation in Medicare and Medicaid coalition (known as the AIM coalition) to advocate for physicians’ ability to provide care for their patients.
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ACR & AIM
The ACR joined the AIM coalition as part of its efforts to drive the cancellation of the Medicare Part B demonstration project, which would have affected prescribing practices and potentially forced rheumatologists to send their patients to the hospital for infusion treatments.
The Center for Medicare and Medicaid Innovation (CMMI) was responsible for developing the now-defunct Medicare Part B demonstration project, which was less like a true demonstration project and more like a law that would have been applied at the national level. The CMMI was created to develop new innovation models for payment and other related reforms, and this is important work, explains Adam Cooper, MS, ACR senior director of government affairs.
As AIM coalition members look ahead to the reality of reformed payment models and other changes in healthcare, Mr. Cooper says the ACR and the AIM coalition deem it important to support a reformed CMMI in furthering the development of new payment models and other reforms. “It’s important that we support the agency in its intended, basic role and to offer constructive ideas for supporting that mission, while ensuring proposals like the Part B demo never happen again.”
6 Reform Principles
With the AIM coalition, the College has been advocating for CMMI reforms that can support this vision for the future, and significant progress has been made so far. This progress includes a meeting in April with Health and Human Services (HHS) Secretary Tom Price, MD, to discuss a letter sent in February to the HHS outlining six recommended principles the coalition believes can be implemented to reform the CMMI. The principles call for the CMMI to:
- Foster strong scientifically valid testing prior to expansion;
- Respect Congress’s role in making health policy changes;
- Consistently provide transparency and meaningful stakeholder engagement;
- Improve sharing of data from CMMI testing;
- Strengthen beneficiary safeguards; and
- Collaborate with the private sector.
As noted in this letter, the ACR and other coalition members agree that as the U.S. healthcare system continues to transition from fee-for-service to value-based care, appropriate testing of new ideas can make healthcare more quality driven, cost effective and patient centered.
“These principles will go a long way toward focusing the important work of CMMI on appropriately scaled projects that align Medicare payment structures with our patients’ healthcare needs. The ACR supports fully transparent, innovative, data-driven ways to make healthcare more valuable and accessible to our patients,” noted Angus Worthing, MD, FACR, FACP, chair of the ACR’s Government Affairs Committee in the initial press release.
Mr. Cooper says, “We see that a CMMI that adheres to the principles presented to Secretary Price can be a highly effective and necessary agent in helping successfully navigate the new world of value-based care.”
Looking to a Reformed Payment Approach
In related reform changes, implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 brings an aggressive timeline for a Merit-Based Incentive Payment System (MIPS) that requires rheumatology practices to report on specific quality measures. Under MACRA, a rheumatology practice can also consider operating under Alternative Payment Models (APMs).
Although there is no current APM tailored to fit the work of a rheumatology practice, the ACR is exploring the feasibility of developing a rheumatology-focused APM that would work for ACR members, Mr. Cooper explains. “A reformed CMMI could prove to be a valuable partner in helping the ACR shape and test a rheumatology-specific APM.”
What You Can Do
As the ACR continues with this policy work to ensure that future reform efforts will still support College members and protect how they practice, every member can be working in their own practice to advance how quality measures are collected and reported, as outlined by the MIPS program under MACRA. One invaluable step: Join the ACR’s Rheumatology Informatics System for Effectiveness (RISE) Registry to allow for automatic collection and reporting of data for MIPS, automatic points toward higher scores and payments, and the collection of quality data to help practices assess how they are doing and where they can improve.
The RISE Registry can also provide data for ACR to use in designing both MIPS quality measures and an APM for rheumatologists. “The more rheumatologists who sign on to RISE, the more helpful RISE can be in unlocking real-world information about describing and reporting high-quality rheumatologic care. It’s truly a win–win for doctors and patients,” says Dr. Worthing.
Follow ACR@Work to keep up with the ongoing work of the ACR and the AIM coalition’s progress.
Carina Stanton is a freelance science journalist in Denver.