17 health care groups urge Congress to pass value-based care bill, extend 5% incentive

Support from health care professionals and their representatives is growing for the The Value in Health Care Act. The bill, which promotes value-based health care, was reintroduced in the House of Representatives in late July. It now comes with a resounding endorsement from 17 health stakeholder groups.

In short, the act is designed to help medical professionals shift away from the current fee-for-service care model, to an Accountable Care model: one in which provider compensation is based on population health outcomes. Myriad studies have shown that fee-for-service favors large patient panels for physicians who are incentivized to prescribe medications and tests rather than spend more time evaluating their patients during office visits. Pressures to meet revenue quotas and to refer patients to other practitioners have driven many practices to merge with hospital systems or sell their practices to investor groups.

The Value Act would encourage physicians to remain independent, spend more time with patients, and receive compensation based on the outcomes of their care.

The original act took several steps in that direction. But most value-based care advocates said it fell short of the support needed to  succeed. The enthusiastic endorsement of the reintroduced legislation by the 17 groups was a sign that this bill represents substantial progress.

Reintroduced by Reps. Darin LaHood (R-Ill.), Suzan DelBene (D-Wash.), Brad Wenstrup, D.P.M. (R-Ohio), Earl Blumenauer (D-Ore.), Larry Bucshon, M.D. (R-Ind.), and Kim Schrier, M.D. (D-Wash.), it includes several improvements to CMS’s existing value-based care programs. Among them:

• It provides a two-year extension of the 5% advanced alternative payment model incentives created by the 2015 Medicare Access and CHIP Reauthorization Act that are scheduled to expire at the end of the year.
• It authorizes CMS to adjust the thresholds to secure those incentive payments so that rural, underserved, primary care or specialty practices can benefit.
• To improve access to care and address health equity, it eliminates the artificial revenue-based distinction that disadvantages rural and safety net providers.
• It calls for a more transparent process to set financial spending targets for ACOs that were previously “penalized” for success.
• It creates a voluntary track for ACOs to take on higher levels of risk.
• It provides technical assistance for clinicians new to APMs.
• It authorizes studies designed to increase parity between APMs in traditional Medicare and Medicare Advantage.

Commenting on these features of the bill, the letter of support said: “We are encouraged that the bill removes revenue-based distinctions that disadvantage rural and safety net providers, which is critical to improving access to care and improving health equity. The bill also improves financial benchmarks so that APM participants are not penalized for their own success. To allow more clinicians to continue the transition to value, the bill establishes a voluntary track for accountable care organizations in the Medicare Shared Savings Program to take on higher levels of risk, and provides technical assistance for clinicians new to APMs. Lastly, the bill seeks to explore the potential of providing parity between APMs and the Medicare Advantage program by studying ways to increase alignment that will ease burdens on physicians and ensure that both APMs and MA are attractive and sustainable options.”

Commenting on the bill’s higher purpose, the letter said: “A key aim of the bipartisan Medicare Access and CHIP Reauthorization Act (MACRA) was to speed the transition to patient-centered, value-based care by encouraging physicians and other clinicians to transition into APMs. While MACRA was a step in the right direction, the transition has been slower than anticipated and more needs to be done to drive long-term system transformations. The Value in Health Care Act helps maintain and further strengthen the movement towards high-quality care where financial performance is linked to the quality of patient care rather than the number of services delivered.”

Related: Alliance calls on Congress to advance value-based care

The letter noted that ACOs have saved billions of dollars for Medicare over the last decade while improving the quality of care for millions of patients. More than 13 million beneficiaries are cared for by an ACO today, making it far and away the largest APM in Medicare. More than 700,000 physicians and other non-physicians participate in Medicare ACOs.

Anders Gilberg, Senior Vice President, Government Affairs, Medical Group Management Association (one of the groups that signed the letter), said the extension of the alternative payment model (APM) was an important element of the bill.

“If enacted, this legislation would provide critical support to practices eager to transition from fee-for-service to value-based care by extending the 5% advanced alternative payment model (APM) incentive payment. In light of another round of proposed cuts to Medicare physician reimbursement, ensuring group practices have the necessary support to succeed in value-based care arrangements is paramount. MGMA looks forward to working with Congress to ensure the passage of this crucial piece of legislation,” Gilberg said.

The supporting letter to Congress accompanying the bill’s reintroduction was signed by the following:

• Accountable for Health,
• American Academy of Family Physicians,
• American Academy of Orthopaedic Surgeons,
• American College of Physicians,
• American Hospital Association,
• American Medical Association,
• America’s Essential Hospitals,
• AMGA,
• America’s Physician Groups,
• Association of American Medical Colleges,
• Federation of American Hospitals,
• Health care Leadership Council,
• Health Care Transformation Task Force,
• Medical Group Management Association,
• National Association of ACOs,
• National Rural Health Association, and
• Premier, Inc.