A bipartisan Senate bill introduced in late December would reinforce Medicare’s move to value-based care.
The Value in Health Care Act was introduced by Sens. Sheldon Whitehouse, D-R.I., John Barrasso, R-Wyo., Peter Welch, D-Vt., Thom Tillis, R-N.C., Bill Cassidy, R-La., John Thune, R-S.D., and Marsha Blackburn, R-Tenn. A companion House bill introduced in July had the support of 17 of the nation’s leading health stakeholder groups.
In late October, more than 630 organizations sent a letter urging Congress to extend incentive payments for participation in risk-bearing alternative-payment models (APMs), which will expire at the end of this year unless Congress acted. “The advanced APM incentive payments have allowed clinicians to cover some of the investment costs of moving to new payment models, including expanding care teams, developing programs to improve beneficiary care and adopting population health infrastructure,” the letter said
The proposed Senate legislation would provide a two-year extension of the 5% APM incentives created by the 2015 Medicare Access and CHIP Reauthorization Act. It also would make several improvements to the Centers for Medicare & Medicaid Services’ value-based care programs, including:
- Giving CMS authority to adjust thresholds to secure those incentive payments, allowing more opportunities to bring rural, underserved, primary care or specialty practices into APMs;
- Eliminating the artificial revenue-based distinction that disadvantages rural and safety-net providers that are critical to improving access to care and improving health equity;
- Creating a fairer, more transparent process to set financial spending targets so accountable care organizations (ACOs) are not penalized for their own success;
- Establishing a voluntary track for ACOs to take on higher levels of risk;
- Providing technical assistance for clinicians new to APMs; and
- Studying ways to increase parity between APMs in traditional Medicare and Medicare Advantage so both programs are attractive and sustainable options.
The National Association of ACOs (NAACOS) supports the Senate bill. According to the association, ACOs have provided Medicare with more than $22 billion in gross savings and nearly $9 billion in net savings since 2012. Today, ACOs care for nearly 20% of all Medicare patients and nearly one-third of traditional Medicare patients.
“ACOs have provided a tremendous return on Congress’s investment, generating billions in savings already,” President and CEO Clif Gaus said. “Lawmakers would be wise to further incentivize value-based care, which has been shown to provide better patient care at lower costs. Lawmakers can start by extending Medicare’s incentives for participating in value-based care models. Continuing these incentives means that clinicians are able to reinvest in improving care and enhancing beneficiary services.”