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Physician groups urge CMS for policies that would allow them to compete with hospitals

Physician groups want risk-bearing models and the ability to offer Medicare Advantage plans to level playing field with health systems.

Susan Morse, Senior Editor

Several physician groups are urging the Centers for Medicare and Medicaid Services to establish a level playing field between hospitals and independent practices to allow physicians to take on the same financial responsibility of value-based models and also to reap the rewards.

Level the playing field for physician practices through policies that create payment parity across practice settings, the physician groups told CMS Administrator Seema Verma. This means leveling facility fees rather than having higher payment for the same service depending on the setting.

[Also: Small practices plagued by complexity of Medicare regulations, show dim view of MIPS, MGMA study shows]

Physicians also want to be allowed to compete in offering Medicare Advantage plans, said the Medical Group Management Association, American Academy of Family Physicians, Aledade and four other groups  Thursday in the letter addressing a request for stakeholder input on future payment models out of the Center for Medicare and Medicaid Innovation.

Physicians want to take on risk-bearing payment models and physician-led advanced  alternative payment models, including  accountable care organizations.

[Also: Smaller practices invest in costly transition to value-based care]

CMS should prioritize a range of physician-led AAPMs including  two-sided,  more advanced,  higher-gain models calibrated  to  reflect the  financial realities faced by small physician practices, as is the case in Track 1+, the letter said.

CMS could consider creating a new, more flexible and sustainable version of Next Generation ACO  for full risk-taking  within  traditional  Medicare, as  well as other new models focused  on  moving physician financials to value.

New models should, over time, put physician practices at financial risk while offering greater reward for taking on risk. The risk must be proportional to the finances of independent physician practices and not so large as to favor consolidation of practices, the letter said. 

CMS should promote competition by cracking down on unfair practices such as data-blocking and non-compete requirements.

"Physicians, especially independent physician practices have repeatedly demonstrated their superior ability to generate positive results in value-based care arrangements, both in improved health outcomes and reduced costs," the letter said.

CMS could adopt policies that allow Medicare beneficiaries to identify to CMS their primary care physician and create models that allow for beneficiaries to share in savings.

Any regulatory changes should not impose substantial new administrative paperwork requirements on already overburdened practices, the physicians said.

"We look forward to working with you to implement and test models that continue to put physicians where they should be at the center of our healthcare system," they said.

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Physician groups want risk-bearing models and the ability to offer Medicare Advantage plans to level playing field with health systems.
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