Healthcare groups urge CMS to count Medicare Advantage contracts as APMs in MACRA

Citing Medicare Advantage contracts' role in improving quality and cost in healthcare, groups representing doctors, hospitals and accountable care organizations are pressing the Centers for Medicare and Medicaid Services to essentially treat those contracts as alternative payment models.

That step, they say, would keep Medicare Advantage relevant, to the benefit of patients in the Medicare program.

The groups -- including the American Medical Association, the Medical Group Management Association and the American College of Surgeons -- outlined their case in a May 31 letter to CMS administrator Seema Verma. They contend that CMS has both the authority and the legal grounds necessary to treat Medicare Advantage as an Advanced APM.

The Medicare Access and CHIP Reauthorization Act, now two-plus years old, altered payment incentives to promote better health, quality and outcomes. It established the Quality Payment Program, under which Advanced APM programs allow providers to shift all of part of their Medicare payment to an APM.

Under QPP, those who meet or exceed the minimum revenue thresholds of Advanced APMs -- or a minimum number of Medicare beneficiaries -- can receive a 5 percent bonus on covered services under the Medicare physician fee schedule from 2019 through 2024. But Medicare Advantage arrangements don't enter that equation until 2021.

The groups want to push that to 2019 and 2020.

To do so effectively, certain steps would need to take place, the groups said. CMS currently has a staged test for determining whether a provider meets certain beneficiary count thresholds, and those would need to be augmented, they said, because Medicare Advantage contracts don't yet have Advanced APM structures built into them.

Financial risk standards would also have to be aligned, they said, since they're different for Medicare than for other payers. The groups cite research showing that the need to manage conflicting requirements from different payers can be a disincentive to participate in the new models, and increase the time and money invested into administrative activities that draw attention away from care.

Medicare Advantage has been gaining in popularity; to date, more than 31 percent of Medicare beneficiaries are enrolled in a Medicare Advantage Program.