Specialists should be able to qualify for alternative payment models under MACRA.

Contact: Aimee Frank

(Bethesda, MD) June 29, 2016 — The American Gastroenterological Association (AGA) participated in a roundtable discussion to express concern to the Centers for Medicare & Medicaid Services (CMS) about the adoption of specialty Alternative Payment Models (APMs) in the Medicare Access and Chip Reauthorization Act of 2015 (MACRA) proposed rule.

Hosted by Sen. Bill Cassidy, R-LA, and Sen. Lamar Alexander, R-TN, the roundtable served as a venue for AGA, physician groups and other medical specialty societies to meet with Andy Slavitt, acting CMS administrator. Participating organizations were those that have or are preparing to implement alternative payment models (APMs).

Many specialty groups, including AGA, have already implemented APMs in the commercial market that are improving quality, while reducing costs. Others are in the process of developing such models. The roundtable discussion provided an opportunity for specialty organizations to demonstrate APMs to CMS as the administration works on the implementation of MACRA. 

“AGA is at the forefront of developing bundle and episode payment models for gastroenterological issues, including colonoscopy screening and surveillance, gastroesophageal reflux disease, and obesity, to help gastroenterologists prepare for success in these new value-driven reimbursement environments,” said Joel V. Brill, MD, AGAF, AGA CPT Advisor, who attended the meeting. “These alternative payment models reward providers for identifying efficiency gains, effectively coordinating patient care and improving quality. Specialist participation in these risk-bearing alternative payment models should be eligible as a qualified APM under MACRA.”

Lawrence R. Kosinski, MD, MBA, AGAF, practice councillor, AGA Institute, from Illinois Gastroenterology Group, Elgin, IL, also participated in the meeting to discuss the importance of population health and value-based payments under APMs. “There is a need to address care management and patient engagement in gastrointestinal disorders, such as inflammatory bowel disease, that can be addressed through alternative payment models that use a team approach to coordinate care.”

CMS needs to be flexible in their regulations to allow the specialty APMs that are already operational and working effectively in the private sector to be eligible for the Medicare program. One such APM, Project Sonar, founded by Dr. Kosinski and built on AGA’s IBD quality measures, has demonstrated that the use of patient engagement tools can result in significant reduction in unnecessary emergency department visits, inpatient hospitalizations and cost of care, while improving medication adherence and health outcomes for patients with Crohn’s disease. 

Other organizations participating in the meeting included the American Association of Neurological Surgeons (AANS), American College of Surgeons (ACS) and American Association of Orthopedic Surgeons (AAOS).

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About the AGA Institute 

The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, the AGA has grown to more than 16,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology. The AGA Institute administers the practice, research and educational programs of the organization. www.gastro.org

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