Major US Healthcare Organizations Recommend Several Changes to Value-Based Care Programs

A group of US healthcare organizations has asked Congress for several changes to help boost engagement in value-based care payment models as laid out in the the Medicare Access and CHIP Reauthorization Act (MACRA). The groups included the National Association of ACOs (NAACOS), the American Medical Group Association (MGMA), and the American College of Rheumatology (ACR). The program thresholds in the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) lay at the center of the organizations’ concerns.

According to Victoria Bailey, “MACRA’s current qualification thresholds are measured based on the individual providers in the APM. This approach has several limitations that make it difficult for some ACOs to qualify. The current qualifying participant (QP) thresholds can also make it challenging for some ACOs to include specialists. To qualify as an advanced APM, APMs must be experts in MIPS reporting and APM regulations, NAACOS wrote. Congress should consider eliminating QP thresholds or varying them based on purpose, such as removing them for payment updates but maintaining them for qualifying for bonuses..”

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(Source: Revcycle Intelligence, November 3^rd, 2022)