IPA and value-based provider advocate organization sends 21 page letter to CMS Director Seema Verma in response to the MACRA Quality Payment Program proposed rule. CAPG, which uses the tagline: The Voice of Accountable Physician Groups, outlines the reasons groups that take risk from capitation should have that work qualify them for the Advance Payment Model under MACRA. The letter postulates that the CAPG capitated model is essential for cost-effective, high quality healthcare. The five percent bonus paid for physicians participating in the current list of advanced alternative payment models (AAPMs) should also be offered to physicians taking risk from a Medicare Advantage (MA) healthplan.
“Under MACRA, certain qualifying models can become eligible for advanced APM status. The statute defines bonus-eligible AAPMs to include Center for Medicare and Medicaid Innovation (CMMI) demonstration projects, MSSP ACOs and demonstrations by federal law.” it goes on to say “Currently no MA arrangements count as AAPMs and MA risk does not count toward an organization’s Medicare risk threshold.” CAPG argues that CMMI should develop a demonstration project that explores rewarding providers for taking capitation risk with a Medicare Advantage healthplan.
The letter goes into specifics about modeling the IPA performance under risk, rather than on each individual physician and the importance of including Part A risk as well as Part B risk, as capitated groups are responsible for Part A spending and at risk for those costs.
Read an article in Cision PR Newswire
Read the CAPG letter to Seema Verma