Welcome to the Accountable for Health (A4H) newsletter, including legislative and Administration updates, accountable care news, and resources.

A4H Activity

A roundup of our recent activity in Washington, DC:

  • Met with the Senate Medicare Payment Reform Working Group to provide recommendations on ways to accelerate the transition from fee-for-service to accountable care. A4H raised the need for Congress to address Advanced Alternative Payment Model (APM) bonuses before the end of this year and discussed long term strategies to encourage the adoption of effective accountable care models.
  • Met with the Energy and Commerce Committee to discuss Medicare Access and CHIP Reauthorization (MACRA) reforms. A4H discussed our MACRA recommendations and ways to better align incentives for providers to participate in accountable care.
  • A4H hosted our quarterly Double Click event this week. The discussion focused on specialty care strategies to advance accountable care. The event featured presentations from A4H member, Connections Health Solutions, the CMS Innovation Center, and the Duke Margolis Institute for Health Policy.
  • Met with Representatives Angie Craig (D-MN), Don Davis (D-NC), Robin Kelly (D-IL), and Terri Sewell (D-AL) to discuss physician payment reforms and ways to advance accountable care.

Congressional News

The House and Senate will both be in session next week before recessing for the Memorial Day holiday.

Senate Finance Committee Releases Paper on Physician Payment and Chronic Care. In the white paper, titled Bolstering Chronic Care through Physician Payment: Current Challenges and Policy Options in Medicare Part B, the Finance Committee highlights advanced APMs as one of its areas of interest, including improving and sustaining meaningful incentives for participation, exploring A-APM bonus payment design as an avenue for physician payment reform, and finding ways to make A-APMs more attractive. The Finance Committee also notes it is “considering repealing or scaling back the MIPS program to relieve physicians’ administrative burden and alleviate churn from advanced APMs back to MIPS.” A4H will continue to provide input to the Committee as they continue their work on physician payment issues.

New Legislation Aims to Transform Pay for Primary Care Providers. The Pay PCPs Act (S. 4338) was introduced by Senators Sheldon Whitehouse (D-RI) and Bill Cassidy, MD (R-LA) this week, aiming to create alternative payment approaches for primary care providers. Specifically, the bill would:

  • Adopt “hybrid payments” for primary care providers in the Medicare Physician Fee Schedule, building on efforts at the CMS Innovation Center, including the newly announced ACO Primary Care Flex Model.
  • Allow CMS to reduce cost sharing by up to 50 percent for Medicare beneficiaries who voluntarily designate a primary care provider who is their usual source of care.
  • Create an advisory committee within CMS to provide technical support on payment rates.

The Senators are seeking feedback on the legislation from stakeholders through a request for information (RFI). A4H will work with our members to respond to the RFI; comments are due by July 15.

Administration

CMS Proposes Mandatory Payment Model for Kidney Transplants. The six-year Increasing Organ Transplant Access (IOTA) Model is intended to improve care quality for end-stage renal disease (ESRD) patients, reduce disparities, and increase the efficiency of participating hospitals. IOTA, scheduled to begin in January 2025, will help establish whether there is a link between performance-based incentive payments and increases in equitable access to kidney transplants, better quality of care, and lower Medicare expenditures. Participants will be subject to upside and downside performance-based payments based on increases in the number of transplants, increased organ acceptance rates, and outcomes. A CMS fact sheet on the IOTA Model can be found here.

CMS Releases New Quality Payment Program (QPP) Data. The annual report on the Merit-Based Incentive Payment System (MIPS) and advanced APMs reviews participation and payment adjustments associated with the Medicare Access and CHIP Reauthorization Act (MACRA). Notably, the report shows that there was a 26 percent increase in the percentage of clinicians participating in advanced APMs from 2021 to 2022 (Table 36), with over 400,000 clinicians participating in advanced APMs in 2022. Also, in 2022, some clinicians received a MIPS bonus of 8.26 percent, a significant departure from previous years where the maximum bonus has been around 2 percent, underscoring the need for changes to MACRA to ensure strong, clear incentives for advanced APM participation.

Annual Medicare Trustees Report. The report estimates that Medicare will be insolvent by 2036, adding five years to the projection from last year’s report. The Trustees attribute the Hospital Insurance Trust Fund’s extended solvency to a range of factors, including a ‘stronger-than-expected’ economy, lower-than-estimated expenditures in 2023, and lower projected spending in the Medicare Advantage program partially due to payment changes, among other factors. The report also calls on Congress to reduce or eliminate the long-term financing shortfalls, but changes to Medicare and Social Security remain politically difficult.

Resources

Center for Health Care Strategies Primer on Developing Primary Care Population-Based Payment Models in Medicaid. The primer explores six design choices for state Medicaid programs to weigh when developing a primary care population-based payment (PBP) model. PBPs are upfront, prospective, value-based payment approaches that incorporate provider accountability in terms of quality and cost of care while moving away from fee-for-service payments. The Center for Health Care Strategies primer also highlights federal and state level examples of existing PBP models, models in the design phase, and other primary care models that could be translated to the PBP design.

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