House Committee Holds Oversight Hearing on Medicare Value ProgramsJuly 6, 2023 Highlights:
By: Congress provided financial incentives for clinicians to transition to value-based care models in 2015 through the Medicare Access and CHIP Reauthorization Act, a law referred to as MACRA. It provided a 5 percent incentive payment to certain risk-bearing APMs, among other changes to Medicare’s payment structure for physicians. APMs encourage keeping patients healthy and improving quality, resulting in better care for patients and lower costs for taxpayers. In the eight years since, the law has been a strong step in the right direction. ACOs account for the majority of Medicare’s advanced APMs, using incentives to hire care managers to provide personal care to their sickest patients, provide transportation and meals, invest in technology, and create 24-7 phone lines so patients can call their primary care provider rather than going to the emergency room. These are services that cannot be reimbursed through Medicare but improve patient health outcomes and wellbeing. In the last decade, ACOs have generated more than $17 billion dollars in savings with $6.4 billion being returned to Medicare, all while maintaining high quality for patients. Now Congress is examining physician payment as a whole, including the success and weakness of MACRA. NAACOS Senior Vice President of Government Affairs, Aisha Pittman, testified before the House Energy and Commerce Committee last month to explain how ACOs are an increasingly critical part of our health system and how Congress can better support ACOs. Below is a summary of many of the key exchanges during last month’s hearing as well as NAACOS’s message to Congress. What are lawmakers saying?
What’s next for MACRA and Medicare’s transition to value-based care? While APMs are transforming how patients in traditional Medicare receive care, adoption of value models has been slower than originally predicted due to misaligned incentives, challenges in APM implementation, and time needed for clinicians and providers to redesign care processes. MACRA was a step in the right direction, but more needs to be done to drive long-term system transformation. NAACOS recommended Congress take the following actions to accelerate the adoption of value-based care going forward. 1) Extend the 5 percent advanced APM incentives and give CMS the authority to adjust qualifying thresholds to promote growth. 2) Redesign physician payment to ensure that clinicians receive adequate payment updates with any additional incentives reserved for clinicians who move into APMs. 3) Ensure participants join and remain in existing APMs by removing barriers that limit participation and giving additional flexibility and tools to innovate care. 4) Work with the CMS Innovation Center to ensure that promising models have a more predictable pathway for being implemented and becoming permanent and are not cut short due to overly stringent criteria. 5) Establish parity between APMs and Medicare Advantage to ensure that both programs provide attractive, sustainable options for innovating care delivery and that APMs do not face a competitive disadvantage. NAACOS is working with our stakeholder partners and congressional champions to include many of these recommendations in an updated version of the Value in Health Care Act in the 118th Congress. |