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.