In a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma, leaders of the U.S. House of Representatives Ways and Means Committee weighed in on several recently proposed regulations from CMS related to burden reduction, including the agency’s overhaul of Medicare’s Accountable Care Organization (ACO) program.
In the letter, written by Committee chair Kevin Brady and chairman Peter Roskam, members of the Ways and Means Committee provided feedback on CMS’s recent proposals, praising many of the recent efforts toward reducing regulatory burden on physicians. The Congressional leaders praised CMS’ efforts to reduce unnecessary and overly burdensome reporting measures in the Merit-based Incentive Payment System (MIPS), revamping the reporting requirements surrounding electronic health records to align with modern technologies and expanding telehealth reimbursement. The congressional leaders also voiced some concerns with other CMS proposals that relate to health IT.
The letter also offers feedback on CMS’ recent proposals to overall the Medicare ACO program, including urging CMS to reconsider its aggressive push to move providers into taking on higher levels of risk. On August 9, CMS proposed a rule that included major changes to the existing MSSP ACO program. Referred to as “Pathways to Success,” CMS’ proposal looks to redesign the program’s participation options by removing the traditional three tracks in the MSSP model and replacing them with two tracks that eligible ACOs would enter into for an agreement period of no less than five years: the BASIC track and the ENHANCED track.
The BASIC track essentially limits ACOs to stay in “upside-only” risk models for just two years, compared to the existing allowance of six years. What’s more, those ACOs in an MSSP Track 1 upside-only model would only be able to get 25 percent of any savings they take in, compared to 50 percent, which is the current max.
In the letter, Brady and Roskam wrote. “It is important that the ACO program reward those who truly are improving care through coordination and doing so while creating efficiencies that might reduce unnecessary spending in the Medicare program writ large,” The Congressional leaders praise the recent changes to expand the use of telehealth for physicians participating in the ACO and allowing ACOs to provide patients with rewards up to $20 for each qualifying high value primary care service.
In the letter, Brady and Roskam also note that CMS is helping to prevent a “massive exit of ACOs” from the program by allowing fur current Track 1 ACOs who contracts are ending in 2018 to have a six-month extension as they apply for a new performance contract.
However, Brady and Roskam also urged CMS to consider the stability of ACOs as organizations take on more risk. As new contracts for shared savings arrangements are drawn up, a component of these negotiations should include some level of regulatory and payment stability for the length of the agreement across all aspects of Medicare, the letter states.
The letter also urges CMS to ease up on its aggressive stance on moving ACOs into higher levels of risk. Specifically, the letter asks CMS to reconsider the proposal to reduce the shared savings amount down to 25 percent, as this may “hinder an ACO from being financially able to take on higher levels of risk,” they wrote.
Following the proposed rule’s release, the National Association of ACOs (NAACOS), a coalition whose members include more than 300 ACOs, criticized the proposed changes, noting that reducing the savings to 25 percent would make it difficult for new ACOs to recoup needed investments to become successful ACOs.
NAACOS President and CEO Clif Gaus said in a statement, “The downside financial risk for patient care would be on top of the significant financial investments ACOs already make, jeopardizing years of effort and investment to improve care coordination and slow cost growth.”
The letter also provides feedback on CMS' propsed Physician Fee Schedule changes. On July 12, CMS released a 1,473-page proposed rule that updates to the Physician Fee Schedule and Quality Payment Program (QPP), which encapsulates the Medicare Incentive-based Payment Program (MIPS) and Advanced Payment Models. That proposed rule included major reforms to Evaluation and Management (E/M) payments including single blended payment rates for both new and established patients for office/outpatient E/M level 2 through 5 visits and a series of add-on codes to reflect resources involved in providing complex primary care and non-procedural services.
In the letter, Brady specificially calls into question CMS’ intention to reduce the number of evaluation and management coding categories from five to two. While this supports the “spirit of burden reduction,” the adjustment “may be an oversimplification that could result in unintended consequences,” the Congressman wrote. “We ask that you take a more deliberate approach working with stakeholders, and consider a policy with at least three coding categories, including considerations such as patient risk scores in addition to time spent, to ensure higher levels of accuracy while still reducing burdens.”