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AGA meets with CMS, Congress to support alternative payment models under MACRA
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The AGA met with CMS and Congress this week to express its support for specialty alternative payment models under the Medicare Access and Chip Reauthorization Act of 2015, or MACRA, which proposes a new Medicare reimbursement system that is expected to become effective in 2017 and begin affecting payments in 2019, according to a press release.
“While MACRA was intended to lessen the burden for physicians caring for patients, CMS proposed rules that make the burdens worse in many areas,” the AGA wrote in a previous press release, announcing its comments on the proposed rule in a letter to Andy Slavitt, acting CMS administrator. “AGA’s comments to CMS asked for dozens of changes that are needed to make MACRA work for gastroenterologists without limiting patients’ access to crucial specialty care.”
At the roundtable discussion hosted by Sen. Bill Cassidy, R-LA, and Sen. Lamar Alexander, R-TN, the AGA and other physician groups and medical specialty societies that have or are preparing to implement alternative payment models, met with Slavitt to express their concerns.
“AGA is at the forefront of developing bundle and episode payment models for gastroenterological issues, including colonoscopy screening and surveillance, gastroesophageal reflux disease, and obesity, to help gastroenterologists prepare for success in these new value-driven reimbursement environments,” Joel V. Brill, MD, AGAF, AGA CPT Advisor, who attended the meeting, said in the press release. “These alternative payment models reward providers for identifying efficiency gains, effectively coordinating patient care and improving quality. Specialist participation in these risk-bearing alternative payment models should be eligible as a qualified [alternative payment model] under MACRA.”
Lawrence R. Kosinski, MD, MBA, AGAF, practice councillor, AGA Institute, from Illinois Gastroenterology Group, also attended the meeting and discussed the importance of population health and value-based payments under alternative payment models.
“There is a need to address care management and patient engagement in gastrointestinal disorders, such as inflammatory bowel disease, that can be addressed through alternative payment models that use a team approach to coordinate care,” he said in the press release.
The AGA called for flexibility in CMS regulations so that existing specialty alternative payment models that are working effectively in the private sector can be eligible for the Medicare program, citing Project Sonar, founded by Kosinski, as an example. Built on the AGA’s IBD quality measures, Project Sonar has shown that using patient engagement tools can significantly reduce “unnecessary emergency department visits, inpatient hospitalizations and health care costs, while improving medication adherence and health outcomes for patients with Crohn’s disease.”
Disclosures: Brill and Kosinski are affiliated with the AGA.