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JOIN NAACOS CALL ON FINDING FRAUDULENT CLAIMS
Registration is open for the NAACOS Discovery Call on potential durable medical equipment (DME) fraud within your ACO. NAACOS has heard from ACO members who have identified potential issues of fraud in their claims data, particularly around durable medical equipment. To better assist members, NAACOS is holding a call to discuss the issue with members. We’ll review best practices for alerting CMS and the HHS Inspector General along with what NAACOS is doing to help ACOs looking to have these claims removed from their performance year expenditures.
NAACOS COMMENTS ON PROPOSED INFORMATION BLOCKING PENALTIES RULE
On January 2, NAACOS submitted comments to CMS and the Office of the National Coordinator on Health IT (ONC) in response to a proposed rule implementing disincentives for information blocking. The rule would apply certain disincentives to health care providers and hospitals for information blocking, including financial penalties. Importantly, the rule would prohibit participation in the MSSP if the ACO or clinicians in the ACO were found to have committed information blocking. More information on the proposed rule is outlined in the NAACOS summary. In this letter, NAACOS raised concerns with the proposal to prohibit participation in the MSSP as a penalty for health care providers that have committed information blocking and stressed that this approach penalizes patients by blocking participation in value models aimed at improving patient care. Other key recommendations in the letter urged CMS and ONC to:
- When information blocking is found to have taken place, CMS should apply a Corrective Action Plan rather than imposing financial penalties.
- CMS should focus first on establishing a joint CMS-ONC educational campaign to increase awareness among health care providers in regard to what constitutes information blocking.
- CMS should avoid double penalizing health care providers found to have committed information blocking by removing penalties that affect MSSP participation. Applying multiple penalties is duplicative and overly punitive, and it will create undue confusion and complexity.
- CMS must more clearly outline the appeals rights of ACOs and the clinicians in an ACO, which should be aligned with those afforded to health IT developers and vendors.
The full letter is available.
CONGRESS LOOKS FOR AGREEMENT TO EXTEND GOVERNMENT FUNDING
As lawmakers return from the holiday recess, congressional leaders are still discussing options to extend government funding and pass health care extenders. The clock is ticking as they only have several weeks before the next funding deadline.
APM Bonus Extension and Physician Payment Cuts — The House Energy and Commerce Committee approved several health care bills in December, including a short-term extension of Medicare’s advanced alternative payment model (APM) incentives and a partial offset of the 2024 Medicare Physician Fee Schedule cuts. The Senate Finance Committee approved similar bills in November that would extend value-based care incentives and adjust physician payments for 2024. These bills did not pass prior to the end of the year and will need to be addressed in the coming weeks.
NAACOS has been lobbying members of Congress to support an extension of Medicare’s incentives for advanced APMs. While we are pleased that an extension of these incentives remains a congressional priority, the cost of extending the incentives will continue to be our limiting factor. NAACOS, along with our congressional champions, will continue to advocate for the highest possible incentive payment for clinicians in advanced APMs.
SENATORS REINTRODUCE THE VALUE IN HEALTH CARE ACT
Sens. Sheldon Whitehouse (D-RI), John Barrasso (R-WY), Peter Welch (D-VT), Thom Tillis (R-NC), Bill Cassidy (R-LA), John Thune (R-SD), and Marsha Blackburn (R-TN) introduced a Senate version of the Value in Health Care Act. The bill extends Medicare’s original 5 percent advanced APM incentives for two years, adjusts qualifying thresholds, makes improvements to MSSP benchmarks, and provides more technical assistance for new ACOs. A companion House bill (H.R. 5013) was introduced in July and had the support of 17 of the nation’s leading health stakeholder groups. A NAACOS press release is available. Ask your members of Congress to cosponsor the bill today!
HOUSE MEMBERS INTRODUCE LEGISLATION TO REFORM CMMI
Reps. Adrian Smith (R-NE), Vern Buchanan (R-FL), and Brad Wenstrup (R-OH) introduced legislation to reform the Center for Medicare and Medicaid Innovation (CMMI). While the bill is improved from prior versions, we still have concerns that the bill limits the number of models tested, requires judicial review, and establishes a process for congressional input on model expansion. We are encouraged that the bill includes public input into model design and changes, addresses overlap, and creates more transparency with reporting to Congress.
MATERNAL HEALTH MODEL ANNOUNCED BY CMS
CMS has announced a new model aimed at improving maternal health outcomes. The Transforming Maternal Health (TMaH) Model will provide states with funding and technical support that will address access to care, improve education, build care teams and support quality improvement efforts. States can receive up to $17 million over 10 years. More information, including the press release, fact sheet, and model overview are available online.
ACO REACH SAVINGS UPDATED BY CMMI
ACO REACH participants combined for an average savings of 5.1 percent compared to their benchmark through the first three quarters of 2023, according to the most recent data from the CMMI. Notably, CMMI applied the model’s retrospective trend adjustment (RTA) with this quarterly update. Benchmarks for aged and disabled patients fell 3.53 percent and 5.15 percent for ESRD patients because of the RTA. Performance on quality measures remained relatively unchanged through the third quarter. The full quarterly update is available.
CMMI also published updated resources and guidance for Performance Year 2024, which are available on the model’s website. Also, CMS published a summary of its 2024 model updates, which NAACOS has previously summarized.
FINAL CPC+ EVALUATION PUBLISHED
The fifth and final evaluation of the Comprehensive Primary Care Plus (CPC+) model was released in December. Findings show CPC+ reduced emergency department (ED) visits, acute inpatient hospitalizations, and acute inpatient expenditures. The report also reveals a continued pattern of positive interaction between CPC+ and MSSP participation. While the model did not reduce total Medicare expenditures or achieve net savings, practices simultaneously participating in MSSP did achieve reductions in expenditures in the later years of CPC+. Findings at a Glance provides an overview of the findings from the final report.
ONC FINALIZES CERTIFICATION UPDATES RULE
ONC recently finalized a rule outlining new certification program updates, including new and updated standards, certification criteria and implementation specifications. The rule also establishes a new baseline version of the United States Core Data for Interoperability (USCDI), Version 3 to replace USCDI Version 1 as the standard effective January 1, 2026. More information is available in this overview of the rule.
RESERVE YOUR SEAT NOW! 2024 BOOT CAMPS ARE IN ONE MONTH!
Join us February 8-9 at the Marriott Orlando Airport Lakeside for our 2024 Boot Camps. Two concurrent boot camps will teach ACOs how to succeed in essential functions. One will focus on data and analytics, sponsored by Wakely and Diagnostic Robotics, and a second will cover best practices for clinical operations, sponsored by Brilliant Care and iRhythm. Participants must register for one boot camp and may attend only that one. Daily lunches and a reception will be held jointly so that attendees at both boot camps may benefit from increased networking opportunities. These boot camps are only offered for in-person participation. There is no virtual option. Boot camps are not open to business partners. Space is limited to 100 people per boot camp.
Register NOW!
Discounted room rate ends next week for boot camp hotel! All reservations must be made by January 12, 2024, to qualify for the discounted room rate of $229 single occupancy per night plus state and occupancy tax (based upon availability). NAACOS does not have the ability to extend this rate. Reservations made after this date are subject to availability based on space and current rates.
DETAILED AGENDA NOW AVAILABLE FOR SPRING 2024 CONFERENCE
Meet us at the Baltimore Hilton Inner Harbor on April 10-12 for the Spring 2024 Conference! The detailed agenda is now available and features leading health care experts and CMS officials sharing timely and essential information for ACOs. Registration is now open for both in-person and virtual participation. Member ACOs get an additional discount when they register groups of individuals. More information can be found on our website. Register early and save!
Sponsor and exhibit opportunities for the Spring 2024 Conference are now available! Reserve your space today!
JOIN THE AWV LEARNING LAB TO START THE YEAR OFF RIGHT
Join us January 18 from 2:00 to 3:30 pm ET for the next Annual Wellness Visit (AWV) Learning Lab session to get a jump start on your yearly results. This month we will hear from Christine Seel Ritchie MD, MSPH, Director, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, and Professor of Medicine, Harvard Medical School. Dr. Ritchie will discuss “Better Care for Older Adults with Complex Care Needs: The Role of the Annual Wellness Visit.” If you are an ACO member who has interest in the AWV process and have not yet registered to attend this AWV Learning Lab series, you can Register NOW! These sessions will continue monthly through March 2024.
| WHAT WE’RE WATCHING: NEWS ABOUT ACOS AND HEALTH CARE |
- A Health Affairs blog lays out ways to try to improve specialty engagement within ACOs.
- Former White House health advisor credits payment reform, including ACOs and work from CMMI, for the recent slowdown in health spending.
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