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Premier’s Blair Childs: Perspectives on Medicare Risk for Accountable Care (part 2)

June 14, 2015
by Mark Hagland
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Premier Inc.’s Blair Childs looks at this juncture in the forward evolution of accountable care—and what healthcare leaders need to do next

Following the announcement June 4 of a revised rule on accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP), published earlier this month by the Centers for Medicare & Medicaid Services (CMS), Premier Inc. released a statement from Blair Childs, senior vice president, public policy for the Charlotte-based health alliance. That statement expressed mixed reactions to different elements of the new rule for the MSSP.

HCI Editor-in-Chief Mark Hagland interviewed Childs shortly after Premier Inc. had released the statement. In the first part of this two-part interview, Childs opined specifically regarding the new ACO rule. In this second part of the interview, he shares broad perspectives on the forward evolution of U.S. healthcare and the impact of that evolution on patient care organizations nationwide. Below are excerpts from that interview.

In looking at the sweeping policy, reimbursement, and regulatory changes sweeping U.S. healthcare provider organizations right how are you and your colleagues framing that set of changes for your members these days? You can speak to specifics in the new ACO rule and more broadly.

You know, there are a lot of decisions you need to make with regard to the new ACO rule in terms of how you want to structure things. So there’s more decision-making involved. So we’re very actively involved in decision-making on that, and in terms of help0ing people understand what the MACRA [the Medicare Access and CHIP Reauthorization Act of 2015, which repealed the sustainable growth rate (SGR) formula for physician payment under Medicare, and which ends physician payment incentives  under the meaningful use program within the HITECH (Health Information Technology for Economic and Clinical Health) Act, and those under the Physician Quality Reporting System (PQRS), replacing the incentives in those programs with a new program called the Merit-based Incentive Payment Program, or MIPS. Physicians will also be able to opt for an alternative program involving slightly higher payments in return for participation in certain Alternative Payment Models, or APMs] means, and what they should be doing to prepare for it.

Blair Childs

What do the c-suite leaders hospitals, medical groups, and health systems need to be doing right now, with regard to these physician payment changes, which can really change how hospitals and physicians will interact with each other?

I think step 1 for the c-suite leaders of any U.S. patient care organization is to figure out your physician alignment strategy, your governance model, your compliance model, and so on. What is your model? Is it based on extensive physician employment, or is it based on independent, clinically integrated networks? How you structure all that will be critical to your success. And beyond that, how do you redesign care? How do you monitor and track that? All of this depends on as strong health information system, to both report the measures, to continue to report, either in MIPS or in an alternative payment model. It’s about risk predictive modeling, and everything related to that.

What’s your sense of what the policy landscape will be like for the next year?

It’s interesting. Very little has happened on the health policy front, on a legislative level, since the ACA [Affordable Care Act] passed since 2010, if you think about it. This year, we’ve gotten MACRA—the SGR reform—and the 21st Century Cures Act [which would overhaul how innovative medical technologies are regulated by the federal government] is moving forward, as are pieces of legislation. We actually could see a not-insignificant amount of healthcare-related legislation pass both houses of Congress next year, because the Republicans are very focused on demonstrating that they could be a responsible governing party. So there’s more happening I think than people are even aware of.

At the same time, depending on what happens—if the Supreme Court rules for King in King v. Burwell [the case before the U.S. Supreme Court, in which, as the Wikipedia article on the case explains it, the legal “challengers argue that the ACA only allows for subsidies on state-run exchanges, and that the regulation as implemented by the Internal Revenue Service (IRS), providing for subsidies on state-run exchanges as well as federal exchanges, exceeded the authority Congress granted to it” ], all bets are off. [The Supreme Court is expected to rule on King v. Burwell before the end of June, when its judician term ends for the year.]

Could that ruling really eviscerate the ACA law?

I think if they [the justices of the Supreme Court] rule for King, it will really require a lot of attention on Capitol Hill

They’ll have to repair or revamp the legislation, at that point?

Yes, essentially.