AMGA Says MACRA Regs, Data Issues Are Key Stumbling Blocks To Value-Based Care

Value-based care can reduce U.S. medical costs, but first providers need the right data in the right format and some current MACRA requirements need to be deep-sixed or changed dramatically, according to a healthcare trade organization.

AMGA, which represents multispecialty practices and integrated health systems, recently sent a letter to Senator Lamar Alexander, chairman of the Senate Health, Education, Labor, and Pensions committee sharing its ideas on what it will take to lower U.S. healthcare costs.

In the letter, the group came out strongly for value-based care models but suggested that there are still big obstacles to making the shift work.

One of the group’s top concerns is that its members are having trouble getting their hands on claims data. According to the letter, most payers won’t give it up, a problem which it says is making population health management efforts difficult. AMGA is asking Congress to demand that federal and commercial payer offer claims data access to providers participating in value-based care efforts.

Even when payers do share claims data, making use of it can be quite a challenge, the group said. “Different contracts require medical groups to submit varying types of data in various formats, creating a massive administrative burden,” wrote Jerry Penso, MD, MBA, the group’s president and CEO and the letter’s author.

The letter also slams key aspects of the current implementation of MACRA which, the letter argues, “has significantly slowed the evolution to a value-based system through policies that limit participation in value-based programs.”

MACRA is blocking the transition to value-based care due to CMS’s decision to exclude some providers from MIPS requirements, Penso writes. By excluding many small practices and solo practitioners from MIPS requirements, that leaves 58% of providers exempt from MIPS requirements in performance year 2019.

This has essentially gutted the entire MIPS program, the letter argues. “MIPS no longer rewards providers for superior performance and provides no return on investments made to improve patient care while saving the system money,” Penso wrote. “Instead of a way to transition to value, MIPS has become an expensive regulatory compliance exercise with little to no impact on quality or cost.”  Not surprisingly, the AMGA is asking that all providers be required to participate in the program.

Meanwhile, AMGA would like to see CMS expand the APM model by lowering the threshold providers must reach to participate. Right now, in 2019, 25% of a providers Medicare revenue must come from APMs, a share which jumps to 50% in 2021 and 75% in 2023.  Penso’s letter argues that these APM levels “will not attract the critical mass of physicians and medical groups needed to ensure success.”

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

1 Comment

  • Small providers were exempted from MIPS participation because the bureaucratic and recording requirements were so onerous, isn’t that right? It seems like a calculated choice has backfired.

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