OVERVIEW

The Academy Advisors will maintain specific focus on three areas of importance to Leading Health Systems in 2018:

 

  1. Care Transformation and Payment Reform

  2. Stark/Barriers to Integration

  3. Medicare/Medicaid Reimbursement & Structure

 

Additionally, we will expand policy development activity to include working groups that strategically address long‐term issues of significance.

I. CARE TRANSFORMATION & PAYMENT REFORM

Medicare Access and CHIP Reauthorization Act (MACRA) Implementation

Since 2016, through educational writings, CMS or legislative comment letters, in‐person meetings, and The Academy Government Payer Collaborative (formerly the MACRA Collaborative), The Academy Advisors has taken a leading role in influencing the roll‐out of MACRA and educating Leading Health System executives. With 2018 serving as the second performance year for the MACRA Quality Payment Program (QPP), The Academy Advisors will continue to play a leading role in educating and advising.

Accountable Care Organizations – Transitioning to Risk-Bearing Models

 

CMS has shown considerable interest in developing new Accountable Care Organizations (ACO) models—most recently the Track 1+ model—to encourage physicians, hospitals, and other stakeholders to collaborate and share savings. ACOs continue to be important to Leading Health Systems, both strategically and as they relate to MACRA. The Academy Advisors will continue to take a leading role in convening Leading Health Systems to share forward-thinking solutions with CMS and Congress. The Advisors will continue to monitor the work from the Medicare Payment Advisory Commission (MedPAC) and other regulatory bodies regarding ACO developments.

II. STARK/BARRIERS TO INTEGRATION

Reduce and/or Eliminate Regulatory Barriers that Impede Delivery of Integrated Care

For the last three years The Academy Advisors has maintained a leading role on Stark reform efforts. We have worked with health systems and outside experts to develop and introduce draft legislation that reforms Stark. Our legislation establishes definitional clarity, accommodates government and commercial innovative payment models, and includes technical corrections to simplify existing regulations. The Academy has been active on these efforts through a smaller working group, coordinating principles and guiding the drafting and advancement of legislation. The legislation is now in its final form and interest on Capitol Hill in reforming Stark has increased. Several other groups have followed our lead and introduced bills and we are actively working to coordinate with these other efforts. We see opportunities this year to introduce our bill, and the priority for our Stark work will be to have legislation introduced by the end of the year.

III. MEDICAID/MEDICARE REIMBURSMENT

Structural Reform to the Medicaid Program

CMS under Administrator Seema Verma has moved quickly to reform the Medicaid program, primarily through the use of Innovation Center waivers promoting state flexibilities in determining how Medicaid services are funded and delivered. While the direction of the Medicaid program will largely be determined by state action, The Academy Advisors will continue to monitor federal developments and the climate surrounding Medicaid reimbursement over the next year through our Government Payer Collaborative. We will track the uptake of Medicaid work requirements, trends in Medicaid leadership at the state and federal level, and the impact of Medicaid reform for provider organizations as a whole.

Productivity Adjustments

Productivity adjustments—reimbursement reductions that were included in the Affordable Care Act as part of the $155 billion that hospitals gave up in exchange for coverage expansion—will have a damaging impact on provider Medicare reimbursement over the next decade if they are not changed. Without modification the productivity adjustments each year to hospital reimbursement under the Inpatient Prospective Payment System will drive Medicare reimbursement lower. The Academy Advisors will be a leading voice in educating policymakers to the impact of these reimbursement reductions and supporting—along with other stakeholders—efforts to remedy the problem.

IV. OTHER PRIORITY ISSUES

 340B Drug Discount Program

Cuts to the 340B Drug Discount went into effect on January 1st, 2018—while Congress continues to deliberate how to regulate and modify the program, The Academy Advisors will support and create a collaborative environment for those member systems affected by 340B-related issues, facilitating interactions with key policymakers and regulators. Though other trade groups are more active on 340B advocacy, The Advisors will assist those systems wishing to take a proactive, solutions-driven approach to addressing foreseeable legislative and regulatory changes to the 340B program.

 

 

Telehealth Expansion

We are working with member systems to advance efforts to broaden reimbursement for telehealth services within traditional fee-for-service Medicare, particularly in light of opportunities to use telehealth to achieve savings in alternative payment models. While CMS has been receptive to allowing telehealth in high risk-bearing arrangements, The Advisors seeks to provide input to CMS about the value of telehealth and the innovative ways in which members have incorporated telehealth into their organizations to improve access and quality for patients.

 

 

Hospital and Physician‐based Quality Metrics

The Advisors will engage with policy‐makers and quality organizations to advance the design or appropriate measures and metrics for hospitals and physicians, specifically as it applies to the MIPS track under the new MACRA regime and other new Medicare programs. In addition, The Advisors seeks to better understand the quality reporting burden for large providers and support CMS’s efforts in the Meaningful Measures Initiative aimed at improving the relevance of these quality metrics for practice.

 

 

Regulatory Relief

In addition to our Stark efforts, The Advisors will develop a targeted regulatory reform strategy that focuses on the 3‐4 areas that are most important to Leading Health Systems and are most likely to be achievable with the new administration that has specifically signaled their interest in regulatory relief initiatives.

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