Message from Thomas A. Janus, DO

Information regarding the Alliance’s participation in NextGen ACO( NGACO) is still embargoed by CMS/CMMI. Because this newsletter is available to non Alliance members, I am not permitted to discuss our status with the NGACO application at this time.

I would like to review the advantages of moving to the NGACO program rather than staying in the MSSP plan or doing MIPS. Embedded within NGACO are unique features, some designed to improve quality and efficiency and some which will clearly improve our financial success.

Being of the mindset when we succeed in improving our quality and efficiency our financial performance will improve, let’s address these aspects first. NextGen offers the opportunity to utilize certain waivers of standard care, which when employed will provide new treatment approaches enabling better outcomes and enhancing efficiency.

The first of these waivers is the ability to implement a Telehealth program, in which physicians can have virtual interactions with patients who are not in the office/hospital and be reimbursed for these services. Imagine the ability to better assess patients not in the office as to whether an ER visit is required or not. Our goal of the right care at the right place at the right time is more achievable. The expansion of this waiver to other settings is so powerful in our ability to create improvements of how we care for patients.

Another waiver granted by participating in NGACO permits physicians to send licensed clinicians, including nurses, into the homes of NGACO patients post discharge and likewise be reimbursed for these services. This should assist in smoother transitions from hospital to home, leading to fewer readmissions and better patient outcomes.

Other waivers will eliminate the need for a three-day hospital stay for patients requiring nursing home admissions from home. Still another waiver will actually pay patients $25 to complete their Annual Wellness Visit.

The financial benefits of NGACO are likewise quite extensive and likely more familiar to our Alliance members. Included would be the 5% bonus all physicians would receive to their part B Medicare reimbursements as NGACO qualifies as an Advanced APM model. This exonerates Alliance physicians from the potential risk of downside reimbursements associated with the MIPS world. Likewise, being in an aAPM alleviates the tedious reporting required by physicians in MIPS.

NextGen also has unique features that permit the Alliance to bring home 100% of the dollars we saved in caring for our patients. These features include the elimination of a minimum savings rate, every dollar saved below our target is ours. Our benchmark year is 2014 for the first three years of the program. So all the work the Alliance has done in the past 4 years to reduce spending will play to our advantage. And perhaps most comforting for all physicians within the Alliance, in a financial risk program, there is absolutely no financial risk imposed upon the physicians.

NextGen can clearly be a revenue source for the Alliance. Considering our Medicare patients are typically our most complex group of patients to treat, yet reimbursement for theses services is near the lowest, any additional stream of income for caring for these patients is welcome. Additionally, as CMS/CMMI test new care management approaches, we are very fortunate to be on the ground level of offering these services, which will benefit not only our patients but also streamline our workload. I anticipate great outcomes for the Alliance and our patients in the NextGen program. Clearly this is the best option for MWMD as we move forward.