Physician Payment Top of Mind for Lame Duck. Congress will return to D.C. on November 12 for the post-election “Lame Duck” session. Upon their return, lawmakers must contend with several expiring provisions and reauthorizations, including the expiration of popular COVID-era telehealth flexibilities, extending Advanced Alternative Payment Model (APM) bonuses, and addressing the proposed CY25 Medicare physician pay cut. Ahead of Lame Duck, Rep. Greg Murphy (R-NC) introduced a bill to delay the proposed 2.8 percent pay cut and add an inflationary adjustment of 1.8 percent to physician reimbursement. Congress is expected to pursue a short-term physician pay cut delay ahead of the January 1, 2025, effective date this year, but legislation to reform Medicare physician payment over the longer term will likely be pushed into next year. Here is a resource reviewing other major policies, extenders, and offsets Congress might consider for an end of year package. A4H continues to engage with lawmakers, push them to mitigate cuts this year, and consider additional actions to strengthen accountable care as Congress looks to 2025.

MSSP Results Demonstrate Meaningful Savings and Quality Care. CMS announced that the Medicare Shared Savings Program (MSSP) achieved $2.1 billion in savings in 2023, with total cost savings for Medicare likely closer to $4 billion when accounting for spillover effects in Medicare Advantage. Notably, this is the seventh consecutive year MSSP has achieved savings. The release also noted that ACOs scored better on many quality measures than other types of physician groups and continued to demonstrate quality improvement. As of January 2024, nearly 500 MSSP ACOs, including over 600,000 clinicians, provide care to nearly 11 million Medicare enrollees. A4H is excited to see the continued strong MSSP performance. CMS reiterated its goal of having 100 percent of beneficiaries in an accountable care relationship by 2030. A4H expects to see additional policies in the Medicare Physician Fee Schedule Final Rule that strengthen MSSP.

Third Cohort Announced for AHEAD Model. The Centers for Medicare and Medicaid Services (CMS) announced that Rhode Island and a sub-state region of New York comprised of five downstate counties will participate in the AHEAD Model, joining Maryland, Vermont, Connecticut and Hawaii. State participants in the model will receive up to $12 million through a Cooperative Agreement to support model implementation over the first five to six years of the model. AHEAD is a state total cost of care model wherein state participants manage health care quality and costs across all payers – public and private – while working to strengthen primary care, improve health equity, and drive down the cost of care. The model is scheduled to run for 11 years, from 2024 through 2034. AHEAD builds on the success of state-based models, including the Vermont All-Payer Accountable Care Organization (VT ACO) Model, which reduced net Medicare spending in Vermont by 9.7 percent, reduced acute care stays, and increased access to primary care.

Physician Fee Schedule Final Rule Clears OMB. The final CY25 Medicare Physician Fee Schedule rule has cleared the Office of Management and Budget (OMB), the final step the rule needs to take before CMS can publish it in the Federal Register. Stakeholders will look to the rule to see the final Medicare physician pay cut and other proposed policies, including changes to Quality Payment Program, mitigation policies for significant, anomalous, and highly suspect (SAHS) billing activity, and MSSP policies.

Brookings Webinar on Traditional Medicare and Medicare Advantage. The Brookings Institute held an event titled, “Medicare’s Two Insurance Systems: Current Performance and Options for Reform.” Panelists discussed the current performance of Traditional Medicare and Medicare Advantage in protecting beneficiaries from cost of illness and ensuring access to care, as well as Medicare’s performance paying health insurers and providers. The session then examined options for reform in each of these domains and discussed how reforms to Traditional Medicare and Medicare Advantage could fit together. The event included some discussion about the role of alternative payment models in the future, but largely focused on issues such as reforming the risk adjustment system, prior authorization, and an out of pocket cap in Traditional Medicare. A recording of the event is available here.

American Heart Association Webinar on Patient and Caregiver ACO Experiences. The November 18 webinar will review findings from confidential interviews with medically complex patients, family caregivers, and health care team members about their perceptions of receiving or providing care through ACOs. The webinar will review the study, its findings and discuss how those findings can inform advocacy efforts to improve care delivery. Register for the webinar here. A4H thanks its members and partners who participated in this study.

A4H Double Click on Accountable Care. Join us on December 12, at the Kaiser Center for Total Health (700 2nd St, NE, Washington, DC) for our next Double Click event. This event will feature sessions looking to the 2025 accountable care agenda, including quality measurement, legislation impacting individuals dually eligible for Medicare and Medicaid, and the future of alternative payment models and the CMS Innovation Center. Register here.

Save the Date A4H @ Health Care Value Week. Join A4H on February 25, for an in-person event in Washington, DC, in conjunction with Health Care Value Week. The event will bring together organizations, stakeholders, and policymakers to discuss accountable care successes and the work ahead. Sessions will include Congressional, community, and provider perspectives on accountable care and the outlook for the future of health care delivery reform. Register here.