WVU Medicine plans for Medicare payment reform

If you are like most clinicians and healthcare administrators, your head is spinning from Medicare payment reform acronyms, such as MACRA, MIPS, MSSP, ACO, AAPM, and QPP. The good news is that WVU Medicine has a strategy and would like to share it with you.

A town hall meeting will be held for providers and administrators at 7 a.m. Wednesday, Sept. 20, in the Bruce McClymonds Conference Center, located on the floor floor of the new southeast tower at J.W. Ruby Memorial Hospital.

As background, the Medicare Access and CHIP Reauthorization Act (MACRA) creates two payment program tracks, together referred to as the Quality Payment Program (QPP): MIPS and AAPMs. By requiring participation in either MIPS or AAPMs, Medicare is forcing providers towards value-based reimbursement. These programs have bipartisan support and are unlikely to go away. Here are some details:

• The Merit-based Incentive Payment System (MIPS) consolidates three existing quality reporting programs: the Physician Quality Reporting System, the Physician Value-based Payment Modifier, and meaningful use. Under MIPS, providers’ payments will be adjusted up to plus/minus four percent in 2019, scaling up to plus/minus nine percent by 2022.
• Alternative Payment Models (APMs) are “a payment approach that gives added incentive payments to provide high-quality and cost-efficient care.” Advanced APMs (AAPMs) are a subset of APMs that enable providers to earn more for taking on additional payment risk. Each APM has a different payment methodology. Additionally, providers participating in Advanced APMs may earn a five percent incentive payment, along with other financial rewards.
• Accountable Care Organizations (ACOs) are one type of APM. Specifically, ACOs “are groups of doctors, hospitals, and other healthcare providers who come together voluntarily to give coordinated high-quality care to the Medicare patients they serve.”  Depending on the model in which an ACO participates, the ACO may qualify as an Advanced APM.

WVU Medicine’s strategy is for all providers to eventually participate in an ACO through the Medicare Shared Savings Program (MSSP). The organization has formed ACO West Virginia to apply to Track 1+ of MSSP beginning Jan. 1, 2018. MSSP Track 1+ is an ACO model that qualifies as an Advanced APM since it offers the opportunity for shared savings payments, as well as the risk of shared losses. 

If ACO West Virginia is accepted to Track 1+, participating physician practices may be exempt from MIPS and will have the opportunity to earn shared savings, as well as a five percent incentive payment.

For year one, WVU Medicine is seeking to include all facilities and physician practices on Epic as of June 30, 2017. For year two and beyond, the organization will seek to include all WVU Medicine providers, as well as closely affiliated independent providers interested in collaborating with WVU Medicine around population health management. 

If ACO West Virginia is not accepted to Track 1+ this year, WVU Medicine will participate in MIPS for another year and then reapply. To ensure compliance with MSSP and maximize the chances of being accepted into the program, providers are encouraged to return any requested attestations they receive to their administrator.

Medicare payment reform can be confusing, but it also presents WVU Medicine with the opportunity to be at the forefront of population health management in West Virginia. Together, we will continue to enhance the value and quality of care we provide to our patients and the community.

All quoted materials are from the CMS website.