Monday Rx | September 17, 2018 | Continuing the Advanced APM Discussion September 17, 2018 Monday RX 836 Last week I shared with membership about the push for Medicare Advantage (MA) arrangements to count towards requirements for Advanced Alternative Payment Models or APMs. In fact, 24 members of the U.S. House of Representatives have written CMS asking the agency to do just that. LACMA member Dr. Fredrick Russo with Facey Medical Group agrees: "We are strongly in favor of Medicare Advantage being qualified as an APM." Next week I will share my conversation with Dr. Russo and others on this important topic. To qualify as an Advanced APM, introduced as part of the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), clinicians have to meet minimum revenue thresholds from certain models or serve a minimum number of beneficiaries in APMs. The final MACRA rule restricts the 2019 and 2020 payment periods to Medicare fee-for-service (FFS) revenue and patients. Those in "other payer" APMs—such as MA plans—won't be able to earn the incentive payment until the 2021 payment year. The congressmen, led by Reps. Tom Reed, R-New York, Tony Cardenas, D-California, Larry Bucshon, R-Indiana, and Earl Blumenauer, D-Oregon, argued, given the risk contracts which already exist in MA and how much of the Medicare beneficiary population is now covered by these plans, they should be included in the beneficiary count needed to qualify for the 5 percent Advanced APM bonus. "Preventing physicians who participate in Medicare Advantage networks from incentives under MACRA is not only a disincentive to their participation in those networks, it could limit patient options, and place further reporting burdens on physicians," the representatives wrote to CMS Administrator Seema Verma, MPH. "To solve this issue, a physician that attests to having a certain percentage of their payments or patients in a qualifying risk-bearing relationship should meet the requirements to participate in the advanced APM track." The letter asks for this recognition to be included in the 2018 QPP rule. An earlier appeal from ten healthcare groups had asked for a less aggressive timeline, with recognition beginning in the 2019 plan year, and the American Medical Group Association said in an interview with HealthExec that MA plans shouldn't be excluded. In the 2019 Quality Payment Program performance year, eligible clinicians can qualify for the automatic five percent bonus under the Advanced APM track by participating in either a qualifying Medicare APM or both a Medicare APM and an other payer model, like risk-based MA plans. This option is known as the All-Payer Advanced APM option. However, eligible clinicians in the All-Payer Model pathway must still meet the 25 percent traditional Medicare revenue threshold to qualify for the bonus, the Medical Group Management Association, America's Physician Groups, Premier, America's Health Insurance Plans, and several other associations recently pointed out. Good for patient care? Patients treated under an MA arrangement with capitation payments had a six percent higher survival rate compared to their peers in other plans, an American Journal of Managed Care study showed. Patients were also 11 percent less likely to visit the emergency department and 12 percent less like to face an inpatient admission. A recent Health Affairs analysis also revealed that patients receiving care through a value-based MA model were three times more likely to receive preventative care visits, and 1.2 percent less likely to use the emergency department. Battling the STI Epidemic I'm pleased to announce LACMA's partnership with key organizations, such as the Los Angeles County Department of Public Health, LA Care and the office of County Supervisor Mark Ridley Thomas, to address the sexually transmitted infection epidemic hitting Los Angeles County. Access to testing, eliminating stigma, provider and patient education are all key pieces to solving the problem which continues to impact pockets of the county. As I learn more, I will share with membership so physicians can be part of the solution. And speaking of LA Care, LACMA is also in conversations with John Baackes, CEO and Richard Seidman, MD and Chief Medical Officer with LA Care regarding the $31 million investment in "elevating the safety net" campaign. Grants to attract new physicians to the LA Care Medi-Cal network and increase healthcare access to low income populations along with an innovative student loan repayment program are the hallmarks of the ground breaking effort. Let me know you if you would like more information. State of Reform Health Policy Conference This week, we will attend the 2018 Los Angeles State of Reform Health Policy Conference at the Los Angeles Marriott Burbank Airport Hotel. All members are invited to join us and connect, network, and discuss the most pressing, most practical health care issues facing the system today. You may register here. State of Reform pulls together practitioners, thought leaders, and policymakers – each working to improve our health care system in their own way – into a unified conversation in a single place. It is sure to be one of the most diverse gatherings of senior health care leaders in Southern California, and one of the most important statewide events in California health care. Gustavo Friederichsen Chief Executive Officer Los Angeles County Medical Association "If it matters to our LACMA members, it matters to me." EVENTS AND COMMUNITY DoubleTree by Hilton, Thousand Cranes Ballroom, 120 S. Los Angeles Street Los Angeles, CA 90012 11 AM - 2 PM WITH SPECIAL KEYNOTE SPEAKER DR. BARBARA L. MCANENY PRESIDENT AMERICAN MEDICAL ASSOCIATION CME Programs MULTIDISCIPLINARY APPROACHES TO CANCER SYMPOSIUM WHEN: September 20 to 23, 2018 WHERE: Loews Coronado Bay Resort 4000 Coronado Bay Road Coronado, CA 92118 Click here for more information. This intensive program will provide participants with an enhanced ability to interpret and apply best treatment options to their individual cancer practices. 5TH ANNUAL GAYLE BRINKENHOFF BREAST CANCER SYPOSIUM WHEN: October 23, 2018 WHERE: Argyros Auditorium, City of Hope 1500 E. Duarte Road Duarte, CA 91010 TIME: 8:00 AM -4:00 PM Click here for more information and click here to register This program will bridge the gap of current practice to include recent developments in disease classification, molecular biology, diagnostic algorithms, testing modalities and therapeutic advances. NEOPLASTIC HEMATOPATHOLOGY UPDATE WHEN: November 8 to 10, 2018 WHERE: The Waterfront Beach Resort, A Hilton Hotel 21100 Pacific Coast Highway Huntington Beach, CA 92648 Click here for more information. Join experts for this exclusive interactive conference. This is a unique opportunity for up-close learning and discussion with experts in the treatment of neoplastic hematopathology. HOW THE EXPERTS TREAT HEMATOLOGIC MALIGNANCIES WHEN: March 21 to 23, 2019 WHERE: Waldorf Astoria, Las Vegas 3752 S. Las Vegas Blvd. Las Vegas, NV 89109 Click here for more information. This two-and-a-half-day symposium has been designed by experts in the field of hematologic malignancies and affords the conference attendee specialized educational tracks for both physicians and nurses, providing an opportunity to learn about the most recent advances in the treatment of bone marrow transplant, multiple myeloma, lymphoma and leukemia. For questions contact: cme@coh.org or 626-218-5622.