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David Introcaso

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Change in CMS primary-care program seen scaring away some providers

February 22, 2017by Robert Whitcomb in Uncategorized tagged , , , ,

The Centers for Medicare & Medicaid Services wants to expand the  model called Comprehensive Primary Care Plus. But an adjustment in how some providers are reimbursed in it could discourage providers from joining, reports Modern Healthcare.

The agency will gather providers into two groups, with “one receiving CPC Plus payments such as care-management fees, performance-based incentive payments or comprehensive primary-care payments, while the other will not,” reported the publication.Paul Ginsburg, a professor of health policy and management at the University of Southern California,  told Modern Healthcare  that the change would make federal attempts to evaluate CPC Plus stronger, but will lead to less participation.

“And there are questions about whether the randomized version of CPC Plus will still count as an alternative pay model under the Medicare Access and CHIP Reauthorization Act.” the publication reported.

Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association, that would be a huge disincentive to providers.

Still, the struggle to win providers could be less to do with CPC Plus itself, and more with the information overload of alternative pay models in recent years, David Introcaso, AMGA’s senior director of regulatory and public policy, told Modern Healthcare.

To read the article, please hit this link.

For integrating MA plans with ACOs

January 5, 2016by Robert Whitcomb in Uncategorized tagged , ,

Healthcare research and policy consultant David Introcaso argues in a HealthAffairs post that  Medicare Advantage plans  should be included in the federal government’s goal to transition Medicare to a value-based payment system.

Part of the explanation for MA plans’ exclusion so far might be that the Centers for Medicare and Medicaid Services  doesn’t know enough about how MA plans reward physicians for quality and value.

In any event,  he says, excluding MA plans from the government’s goal ignores “substantial and rapidly growing” MA spending.  Mr. Introcaso notes that  MA is expected to have more than 25 million enrollees  by 2024, meaning that  about 30 percent of all Medicare payments would be left out of the government’s value-based initiative if the regulations aren’t changed.

He argues for  integrating alternative-payment models — especially Accountable Care Organizations (ACOs) —  with MA plans, although that would require some major regulatory adjustments.

 

 

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