NAACOS Newsletter for Members and Partners November 4, 2021

Table of Contents
CMS Releases Final 2022 Medicare Physician Fee Schedule Rule
NAACOS Releases White Paper on Health Equity and Quality Measurement
Next Gen ACOs Post Another Successful Year in 2020
CMS Makes Changes to Other APMs
Upcoming Webinar: Managing to the New Medicare Patient
Tune In to NAACOS Webinars This November
Democrats Working to Pass Spending Bill
Next Direct Contracting Learning Discussion Scheduled
CMS Releases Second QP Snapshot Data
Two NAACOS-supported Bills Reintroduced in Congress

This week, the Centers for Medicare & Medicaid Services (CMS) released the final 2022 Medicare Physician Fee Schedule (MPFS) Rule. The rule includes updates to Medicare physician payment policies and the Quality Payment Program (QPP) requirements for 2022, and it finalizes key Medicare Shared Savings Program (MSSP) policy changes on quality, applications, repayment mechanisms, and assignment. Importantly, as a result of NAACOS advocacy, CMS finalizes policies to allow ACOs to continue to report using the Web Interface (WI) in 2022, 2023, and 2024. NAACOS has been strongly advocating for changes to the quality overhaul for over a year, and we are pleased to see CMS provide this needed additional delay to allow ACOs to be successful in implementing these changes. NAACOS staff will review these policies in an upcoming webinar on November 12 from 2:00 to 3:15 pm ET.

Some of the key issues affecting ACOs include CMS policies to:
  • Decrease the Medicare conversion factor to $33.598, from $34.89, which was finalized for 2021, a drop of about 3.7 percent.
  • Make changes to the quality reporting requirements for MSSP ACOs, including:
    • Allowing additional time to report using the WI beyond what was proposed, permitting use of the WI through 2024
    • Not finalizing the proposed requirement that an ACO must report at least one electronic clinical quality measure (eCQM) or Merit-based Incentive Payment System (MIPS) CQM in Performance Year (PY) 2023 in order to meet the quality performance standard
    • Maintaining the quality performance standard threshold (30th percentile of all MIPS quality performance category scores) through 2023
  • Ease burdens and costs of ACO repayment mechanisms by cutting in half the percentages used in the existing repayment mechanism amount calculations.
  • Not make changes to MSSP benchmarking or risk adjustment policies, including correcting the "rural glitch." CMS sought comment in the proposed rule and said any policy changes, if deemed appropriate, would come in future rulemaking.
  • Add seven new codes to the list of those used for ACO assignment, including new or revised codes for chronic care management, principal care management, and other evaluation and management (E/M) services.
  • Reduce MSSP application burden by lowering document submission requirements around prior participation and sample and executed ACO participant agreements, only requiring submission of such document upon the request of CMS.
  • Change beneficiary notification requirements for ACOs that select prospective assignment by only requiring notices to be sent to beneficiaries prospectively assigned to their ACO.
  • Remove telehealth's geographic restrictions and add the beneficiary's home a permissible originating site for telehealth for the diagnosis, evaluation, or treatment of a mental health disorders. CMS will require an in-person visit at least every 12 months but will allow audio-only communication in the diagnosis, evaluation, or treatment of mental health disorders.
  • Add new chronic care management (CCM) code, 99437, which describes each additional 30 minutes by a physician or other qualified health care professional, per calendar month.
The CMS MPFS factsheet is provided as well as QPP resources. NAACOS staff are currently reviewing the regulation and will provide a more thorough analysis to members shortly. Should you have any questions, please email us at [email protected].

NAACOS recently released a white paper discussing seven policy changes that CMS could consider to advance the efforts of quality improvement in relation to improving equity in health outcomes across ACOs. The paper builds on a previous white paper authored by NAACOS, discussing model design and policy recommendations to give ACOs the tools and resources they need to implement and deploy interventions to reduce these inequities and improve patient care for underserved populations. Read more about NAACOS' work on this important issue.

NAACOS is proud of the performance of Next Generation (Next Gen) ACOs in 2020, collectively producing $637 million in gross savings and $230 million after accounting for shared savings payments, shared loss payments, and discounts. Next Gen ACOs have increased savings every year of the program, collectively saving more than $1.66 billion in gross savings and $836 million in net savings since 2016. Importantly, these ACOs also hit an average quality score of 96.5 percent in 2020 out of a perfect score of 100, improving care for 1.1 million seniors. Complete 2020 performance results are available in an online public use data file. NAACOS encourages ACOs to share 2020 performance results with internal and external audiences, including the press, and we have developed a media kit to assist you.

The CMS Innovation Center also published the formal evaluation for the first four performance years for Next Gen, which covered 2016–2019, which unfortunately found no net savings to Medicare. NAACOS continues to advocate that the CMS Innovation Center develop a new full-risk option for ACOs under the MSSP. This "Enhanced Plus" option would advance ACOs by providing MSSP a full-risk and capitation option, which to date has only been available in Innovation Center ACO models, along with benefit enhancements, and Tax ID Number-National Provider Identifier (TIN-NPI) level participation. It would also blend elements of MSSP and Next Gen to create a better middle ground between MSSP Enhanced and Direct Contracting. NAACOS issued a press release reacting to the 2020 results, formal evaluation, and Enhanced Plus proposal. A NAACOS summary of ACOs' performance in 2020 is available.

In a series of regulations finalized over the last week, CMS made several changes to additional alternative payment models (APMs) that are run out of the CMS Innovation Center. CMS finalized the nationwide expansion of the Home Health Value-Based Purchasing Model, which adjusts Medicare payments to home health agencies by a maximum, upward or downward, of 5 percent based on quality performance relative to peers. The model launched in nine states in 2016 but has since been certified for expansion based on its ability to lower costs and improve quality. The expanded home health model will launch in 2023 with payment adjustments taking effect in 2025. CMS will use next year to provide technical assistance to agencies on the program. For more information, refer to the fact sheet and final rule.

CMS also finalized changes to the Radiation Oncology Model, which will be mandatory for about 30 percent of the country. The five-year model, which is scheduled to start on January 1, will provide bundled payments for a 90-day episode of care to certain radiotherapy providers treating certain cancer types. Among the changes made by CMS, discounts will be 3.5 percent for professional services and 4.5 percent for technical aspects of care. Fact sheet and final rule.

Last week, CMS finalized changes to the mandatory ESRD Treatment Choices (ETC) Model to improve health equity. The model will reward ESRD facilities that treat low-income patients by creating a Health Equity Incentive bonus and stratifying benchmarks into two groups based on proportion of dual eligible and low-income beneficiaries. The goal of the ETC model is to incentivize transplants and home dialysis, which is lower cost. It increases or lowers payments to dialysis centers based on performance compared to comparison groups in areas not participating in the model. For more information, refer to the fact sheet and final rule.

November 11, 2021 from 2:00 to 3:00 pm ET
The Baby Boomer Generation has already begun to age into Medicare, and its number of beneficiaries is projected to increase to over 80 million — meaning more people than ever before will rely on the healthcare system. In turn, this new Medicare population will drastically shift the current care delivery models and drive higher demand for long-term care services. So, how can ACOs and DCEs prepare for this new Medicare patient? Leading the consumerization of health care, this generation's knowledge of and preferences about real-time access to healthcare data, aging, and quality of life are much different than their parents. During this presentation, we will discuss the importance in establishing new care delivery models and standardizing care within your post-acute network. Insights will also be provided into how post-acute data transparency will play an integral role in delivering the care and transparency that this new Medicare patient will require. Register today for this webinar sponsored by Real Time Medical Systems. This webinar is complimentary for NAACOS ACO and DCE members, but it is not open to Business Partners.

Speakers: Gina Markwell, LNHA, Director, Post-Acute and Transitional Care Triad HealthCare Network, and Phyllis Wojusik, RN, EVP, Health System Solution, Real Time Medical Systems

NAACOS offers its member ACOs and DCEs complementary registration for a variety of webinars this November. Mark your calendar and join us for these important educational opportunities.

November 10, 2:00 to 3:00 pm
Annual Wellness Visits: Lessons Learned in Implementation and Outreach for Virtual Visits

November 11, 2:00 to 3:00 pm
Managing to the New Medicare Patient: Driving New Care Delivery Models with Post-Acute Data Transparency
(sponsored by Real Time Medical Systems, see above article for more information)

November 12, 2:00 to 3:15 pm
NAACOS Review of Final 2022 MPFS Rule Policies (see above article for more information)

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Following recent elections that included some big wins for Republicans, congressional Democrats, and the Biden administration are doubling down on their commitment to pass the Build Back Better plan, which includes universal pre-K, child tax credits, and other spending provisions. Over the past weekend, a slate of scaled back drug pricing provisions were agreed to by congressional leadership as pay-fors for the spending bill, although the essential support of both Sen. Manchin and Sen. Sinema on the overall package continues to remain a hurdle with negotiations ongoing. Progressive Democrats are also continuing to advocate for additional measures to be included in the bill, such as dental and vision benefits, as well as paid family leave. Several issues of interest to ACOs and providers, including repeal of a restrictive telehealth statute and action on the looming physician pay cuts, are slated to be dealt with at the end of the year in a bipartisan fashion, but as the remaining days in the Congressional calendar grow fewer, Congress' ability to dispense with these items is compromised.

NAACOS's Next Direct Contracting Learning Discussion has been scheduled for 2:00 pm ET on November 19. The event is for current, future, and potential DCEs to share feedback, questions, concerns, and points of interest. This is intended to be a collaborative discussion and a forum for shared learning, and we ask that you come prepared to share your perspectives and react to issues at hand. The meeting will take place over Zoom (passcode: 711587). Advance registration is not required, and the meeting will be recorded and posted on our website for those unable to attend it live. If you have issues you'd like to raise, please share them with [email protected].

CMS recently updated the QPP participation status tool to reflect the second PY 2021 evaluation for meeting Advanced APM thresholds, known as QP thresholds. Meeting or exceeding those thresholds is required to earn the annual 5 percent Advanced APM bonus, which will be paid in 2023. The second "snapshot" period focuses on January 1 through June 30, and providers have one more upcoming opportunity to meet the QP thresholds this year. For DCEs this is the first QP evaluation that is based on data from April 1 through June 30. The abbreviated window is a result of the April 1 start date for the Direct Contracting Model.

Importantly, many more providers in ACOs and DCEs will be eligible to earn Advanced APM bonuses as a result of NAACOS's advocacy last year to prevent the QP thresholds from sharply rising in 2021, as they were previously scheduled to before Congress changed them. To learn more about these bonuses, QP thresholds and how to qualify, please refer to NAACOS' resource, The ACO Guide to MACRA.

NAACOS is pleased to see two pieces of legislation it supports reintroduced in the Senate. The Social Determinants Accelerator Act (S. 3039) would establish a federal interagency council to better leverage existing programs and address the barriers to coordination between health and social services programs. The bill would also help states and localities develop innovative strategies to address social determinants in their communities. It is sponsored by Sens. Todd Young (R-IN) and Debbie Stabenow (D-MI). The Improving Seniors' Timely Access to Care Act (S. 3018) would establish an electronic prior authorization process that would streamline approvals and denials, among other things. That is sponsored by Sens. Roger Marshall, M.D. (R-KS), Kyrsten Sinema (D-AZ), John Thune (R-SD), and Sherrod Brown (D-OH). NAACOS has endorsed both bills.