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  • AAFP Advocacy Visible in Value-based Payment Legislation

    Bill Would Make Long-sought MSSP and Bonus Adjustments

    July 30, 2020, 01:42 pm News Staff – The AAFP's repeated calls for Congress and regulators to ensure that family physicians can successfully participate in value-based payment models and accountable care organizations resonate in a new bill applauded by the Academy and 12 other health care organizations.

    value with hand and blue marker

    The Value in Health Care Act, (H.R. 7791) said the groups in a July 24 letter, would ensure that value-based care models and ACOs "continue to produce high-quality care for the Medicare program and its beneficiaries, as well as generate savings for taxpayers."

    The letter was sent to Reps. Peter Welch, D-Vt., Suzan DelBene, D-Wash., and Darin LaHood, R-Ill. In addition to the AAFP, signatories included the AMA, the American College of Physicians and the American Hospital Association.

    Noting that nearly 40% of all health care spending is tied to some form of value-based payment, the groups said, "the policies in this bipartisan bill are also more important than ever, given the acute needs of our nation's health care system as we navigate the COVID-19 pandemic."

    As the Academy told HHS in May, physicians who participate in ACOs and other alternative payment models urgently need support to sustain primary care.

    "The reforms in this legislation will further strengthen ACOs and APMs and ensure their continued success," the July 24 letter said, noting that the Value in Health Care Act "provides appropriate shared savings rates, modifies risk-adjustment methodologies, removes barriers to participation, ensures fair and accurate benchmarks, and provides educational and technical support for ACOs."

    A number of key AAFP priorities are included in the bill, which would

    • increase Medicare Shared Savings Program Basic-track ACO shared-savings rates;
    • allow MSSP risk-adjustment scores to increase up to 5%, while capping decreases at 5%;
    • change the MSSP benchmarking methodology to remove ACO beneficiaries from the calculation;
    • provide advance funding to ACOs to ensure access to capital for initial infrastructure investments;
    • extend the Quality Payment Program Advanced APM 5% annual lump-sum bonus for an additional six years, though 2028; and
    • require CMS to address APM model overlap and remove the restriction on APM participants earning shared savings from multiple programs.

    The bill also would reduce the threshold for the percentage of Medicare Part B payments that must be though an APM in order to be considered a "qualified participant" and eligible to receive the advanced APM bonus. The threshold -- now 50% of all Part B payments -- is set to increase to 75% in 2021. The bill would keep the 50% threshold for 2021 but let HHS to increase it by up to 5% each year, allowing the bonus to continue while encouraging greater participation in advanced APMs.

    AAFP President Gary LeRoy, M.D., of Dayton, Ohio, praised this element of the bill in a July 24 statement.

    "Through extension of the Advanced APM bonus and lowering the threshold for qualifying participants, this legislation ensures that physicians currently participating in APMs are compensated appropriately and incentivizes more physicians to make the move into APMs," LeRoy said.

    Likewise, in testimony before the Senate Finance Committee last year, then-AAFP President John Cullen, M.D., of Valdez, Alaska, called for extending the AAPM bonus. He reminded the committee that the Academy had the previous year called on lawmakers to extend the 5% bonus for at least three years and give HHS discretion to go beyond that.

    The July 24 letter said that this and other reforms in the legislation represented "a comprehensive approach that will strengthen our country's value-based care program and ensure high-quality, lower-cost care for our nation's patients."