AMGA Recommends CMS Monitor Effect of Risk Adjustment Changes
AMGA appreciates the Centers for Medicare & Medicaid Services’ (CMS’) decision to implement significant changes to the Medicare Advantage (MA) risk adjustment model over a three-year period.
Alexandria, VA – AMGA appreciates the Centers for Medicare & Medicaid Services’ (CMS’) decision to implement significant changes to the Medicare Advantage (MA) risk adjustment model over a three-year period. AMGA was concerned that the initial proposal to immediately modifying the model would be needlessly disruptive to AMGA-member providers and patients enrolled in MA plans. Phasing in the changes to the hierarchical condition categories model (CMS-HCC model) will allow CMS to address any unintended consequences of the changes.
“AMGA remains concerned that CMS views this reform as a way to address so-called ‘discretionary coding’ in the risk adjustment model,” said AMGA President and CEO Jerry Penso, MD, MBA. “But, with this more cautious approach, CMS will have an opportunity to refine the plan based on the effects the changes have on providers and their patients.”
AMGA strongly recommends CMS closely monitor not only the effect of the HCC model changes on MA plans, but also how the changes affect providers and patients.
AMGA also continues to support CMS’ efforts to align quality measurements across Medicare. CMS’ “Universal Foundation” quality measure concept is similar to elements of AMGA’s 2018 initiative, which developed a streamlined set of quality measures designed to simplify the reporting process and limit the burden on providers and group practices, while still reporting clinically relevant and actionable data. As CMS continues its work in this area, AMGA and its providers are prepared to offer their experience and expertise to ensure quality measures support the continued transition to value-based care and do not needlessly contribute to administrative burdens.
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About AMGA
AMGA is a trade association leading the transformation of healthcare in America. Representing multispecialty medical groups and integrated systems of care, we advocate, educate, innovate, and empower our members to deliver the next level of high performance health. AMGA is the national voice promoting awareness of our members’ recognized excellence in the delivery of coordinated, high-quality, high-value care. More than 175,000 physicians practice in our member organizations, delivering care to one in three Americans. For more information, visit amga.org