AAFP Guides Agencies Away From Alternative Payment Roadblocks

Letters on Proposed Rules Center on Easing Practice Transformation

January 09, 2020 01:24 pm News Staff

In Dec. 27 letters responding to a pair of proposed rules from CMS and HHS' Office of the Inspector General, the Academy counseled regulators to bolster the health care system's primary care foundation by making sure self-referral rules do not hinder practice transformation through new payment models.

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"The AAFP continues to support physicians moving away from receiving payments in an antiquated fee-for-service context," the Academy wrote(5 page PDF) to CMS Administrator Seema Verma, M.P.H. "Instead, we strongly support efforts to shift primary care payments into alternative payment models and value-based care arrangements that are more consistent with the continuous, comprehensive and longitudinal nature of primary care."

The letter was sent in response to the proposed rule "Modernizing and Clarifying the Physician Self-Referral Regulations"(www.govinfo.gov) that was published in the Oct. 17, 2019, Federal Register.

The AAFP applauded just such an effort in the OIG's proposed rule "Fraud and Abuse; Revisions To Safe Harbors Under the Anti-Kickback Statute, and Civil Monetary Penalty Rules Regarding Beneficiary Inducements,"(www.govinfo.gov) which was also published in the Oct. 17 Federal Register. At the same time, the Academy advised the OIG to ensure that physicians can focus on patients rather than paperwork.

"While supportive of the intent and direction of the proposed safe harbors, the AAFP remains concerned about the level of administrative burden required to comply with these proposed requirements, especially on small and rural practices," the Academy told Joanne Chiedi,(4 page PDF) HHS' acting inspector general.

"By reducing or not creating new administrative burden, OIG can support the patient-physician relationship and let physicians focus on an individual patient's welfare and, more broadly, on protecting public health."

Both letters were signed by AAFP Board Chair John Cullen, M.D., of Valdez, Alaska.

The letter to CMS called on policymakers to address the burden of physician self-referral rules by

  • protecting family physicians' ability to transform their practices and collaborate on team-based, patient-centered care with new technologies and a focus on lowering costs;
  • issuing broad, clear safeguards for value-based payment;
  • removing barriers to care within a value-based framework in the primary care setting;
  • ensuring that Center for Medicare & Medicaid Innovation models use waivers that do not violate self-referral rules, so other payers can use and expand these models;
  • reducing primary care practices' documentation requirements;
  • creating safe harbors that cover operational and financial arrangements, as well as physician practice and flexibility; and
  • creating a simple decision tree to help practices determine when legal opinions may be needed.

Further, the Academy asked CMS for "greater focus on outcomes related to quality and cost and less on procedural safeguards," pointing out that such an approach "would be more consistent with the guiding principle of choice and competition in the market based on quality, costs and outcomes compared to the current approach of subjecting beneficiaries and physicians to increasingly stringent administrivia, coverage criteria and documentation requirements."

The Academy objected to a provision of the OIG's proposed rule that would create a new safe harbor "to protect in-kind remuneration exchanged between qualifying value-based enterprise participants with value-based arrangements that satisfy certain requirements" because it would mandate new costs and more paperwork.

"The contribution requirement adds unnecessary burden and complexity and is potentially cost-prohibitive," the AAFP wrote.

The Academy also advocated for a revised and consistent definition of risk across evolving payment models.

"The AAFP believes the focus on risk should not just be on downside financial risk," said the letter to CMS. "Instead, CMS needs to address other risks, such as upside, clinical, operational, contractual or investment."

Related AAFP News Coverage
AAFP to HHS: Let Physicians Transform Their Practices
Academy Seeks 'Timely, Broad, Clear Flexibility for AAPMs'

(11/6/2018)

AAFP Pushes CMS to Clear 'Safe Harbors' in Stark Law
Self-referral Regulations Should Not Hinder Value-based Models, Academy Advises

(9/15/2018)

Social Determinants of Health, Alternative Payment Models
AAFP Unveils Principles for Fair Measurement, Payment in APMs

(5/18/2018)

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