Among other provisions, the bill extends the 5% advanced APM bonus for an additional six years and modifies thresholds to achieve the bonus.
Thirteen national provider groups support the newly-introduced House bill, the Value in Health Care Act of 2020, a bipartisan effort that proposes to make changes to the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.
The bill specifically amends many of the program parameters of Medicare’s Alternative Payment Models to increase participation.
It extends the 5% advanced alternative payment model bonus for an additional six years, modifies the threshold to achieve the bonus and authorizes a study of the overlap of various Medicare APMs
The 13 organizations told the bill’s cosponsors by letter that they support the Value Act’s aim to accelerate value-based payments in Medicare and boost participation in accountable care organizations and alternative payment models.
The bill encourages participation in the Medicare ACO program by increasing the percent of shared savings beginner participants receive. This is to counteract recent program changes that decreased shared savings, making the program less attractive.
It modifies risk adjustment to better reflect equity and disparity factors.
“The disproportionate impact of COVID-19 on racial and ethnic minorities has highlighted the need for this critical program improvement,” said Dr. Bruce Siegel, president and CEO of America’s Essential Hospitals.
It modifies performance metrics so participants aren’t competing against their own past success.
It also provides greater technical support to ACO participants to cover the significant startup costs associated with program participation.
It relaxes current thresholds for Advanced APM qualification.
The bill also eliminates the artificial distinction between “high” and “low” revenue ACOs, addresses ACOs’ “rural glitch,” and restarts the ACO Investment Model, the providers said.
The letter was signed by the American Academy of Family Physicians, American College of Physicians, American Hospital Association, American Medical Association, America’s Essential Hospitals, America’s Physician Groups, AMGA, Association of American Medical Colleges, Federation of American Hospitals, Health Care Transformation Task Force, Medical Group Management Association, National Association of ACOs and Premier.
The Value in Health Care Act was filed on Friday by Reps. Peter Welch (D-Vt.), Suzan DelBene (D-Wash.) and Rep. Darin LaHood (R-Ill.).
WHY THIS MATTERS
Almost 40% of healthcare dollars are tied to value-based payment, according to the providers. The goal is to increase that percent moving forward.
However, after the Centers for Medicare and Medicaid Services implemented Pathways to Success in 2019 mandating ACOs take on risk as well as shared savings, there’s been a decline in the formation of new ACOs and a flattening of participation.
Clif Gaus, president and CEO of the National Association of ACOs, said “This bill addresses several critical issues that will reignite ACO growth by correcting incentives and better rewarding Advanced APM participation.”
The bill also gives physicians incentive to move into the alternative payment models through lowering the threshold for qualifying participants and ensuring that those currently participating in APMs are compensated appropriately, according to Dr. Gary LeRoy, president of the American Academy of Family Physicians.
American Medical Association President Dr. Susan R. Bailey said, “Alternative payment models can provide support for use of tools such as care coordination, telehealth and remote monitoring, data analysis and aggregation, and patient registries that have proven vital during the COVID-19 pandemic.”
THE LARGER TREND
Under MACRA, providers participating in quality improvement programs can choose between an APM ad the Merit-Based Incentive Payment System (MIPS). The goal of MACRA and the payment programs is to incentivize coordinated, value-based care and its aim of improving quality, outcomes and cost.
ACOs accomplish value-based goals, according to a 2017, U.S. Health and Human Services Inspector General report. The report found that 98% of ACOs, after participating for three years, met or exceeded quality measures and outperformed regular fee-for-service providers on 81% of quality measures, according to information on cosponsor Rep. Suzan DelBene’s website.
“Physicians and hospitals participating in APMs are driving the change in healthcare we so desperately need,” DelBene said. “The ACOs in Washington are doing the right thing by making sure seniors, who are isolating to protect themselves from COVID-19, are accessing nutrition and pharmaceutical prescriptions. This is the exact kind of care coordination that we need. It’s even more critical during the public health emergency.”
“America’s Physician Groups is pleased to support the Value Act because it includes several reforms that will go a long way toward strengthening the ACO model in the Medicare program,” said APG president and CEO Donald H. Crane.
“AMGA members are invested in the move to value-based care and ACOs are a critical part of that transition,” said AMGA president and CEO Dr. Jerry Penso.
“This important bill will help the nation’s teaching hospitals and faculty practice plans as they continue their focus on providing care based on quality as opposed to volume. We especially appreciate the provisions that extend the Advanced APM bonus for six additional years and modify qualifying thresholds so that meaningful participation in AAPMs will be rewarded,” said Karen Fisher, chief public policy officer at the Association of American Medical Colleges.
“The Value Act addresses many of the challenges that have limited the ability of hospitals and health systems to scale these initiatives for their Medicare patients and addresses several barriers to organizing programs for care that are sustainable,” said Chip Kahn, president and CEO of the Federation of American Hospitals.
“Now more than ever, the healthcare industry realizes the drawbacks of ongoing reliance on fee-for-service,” said Jeff Micklos, executive director of the Health Care Transformation Task Force.
“Medical group practices remain committed to the central tenants of value-based payment reform. This legislation makes important updates to the ACO model and improves upon incentives for participating in value-based reimbursement models,” said Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association.