IN WASHINGTON [ ] legislation + regulations + advocacy
By James J. Miller, M.B.A.
As the 116th Congress begins its work, it is clear that there will be numerous opportunities
to address key health policy issues
in the coming year. Last month,
AMGA sent a letter to every Member of Congress underlining the
most important issues for medical
groups and health systems in 2019.
They include: creating a pathway
to value, preserving Medicare
Advantage (MA), promoting care
for the chronically ill, improving
regulations in value-based models,
refining Accountable Care Organiza-
tions (ACOs), preserving access to
advanced diagnostic imaging in the
medical group setting, incentivizing
behavioral health integration efforts,
gaining access to substance use
disorder data, and strengthening
Graduate Medical Education (GME).
Pathway to Value
Policymakers in Congress and the
administration have made clear
their intent to transform the way
health care is financed and delivered in this country. Congressional
passage of the Medicare Access
and CHIP Reauthorization Act
(MACRA) charted our system on a
path to value for providers over the
next few years.
Under MACRA, two new systems
will be fully implemented this year:
the Merit-based Incentive Payment
System (MIPS) and Advanced Alter-
native Payment Models (APMs).
The law mandates provider payment
risk as a way to transition Medicare
payments from volume to value.
AMGA members have dedicated
significant amounts of time and
resources to deliver an even higher
level of care under these new pay-
ment systems. However, we have
concerns and recommendations
regarding the implementation of
these two systems.
Providers participating in the
MIPS program have the opportunity
to earn an annual adjustment to
their Medicare Part B payments
based on their performance starting
in 2019, with a positive or negative
adjustment range of 4%. That
range eventually increases to 9% in
Labyrinth AMGA’s 2019 priorities and recommendations to Congress