Value in Health Act Would Tackle Alternative Payment Model Overlap

Has CMS gone overboard with the number of alternative payment models? Maybe yes, maybe no, but there is a problem overlapping programs and financial incentive.

A key provision of the bipartisan Value in Health Care Act of 2020 introduced in the House in late July would requires HHS to review the overlapping program and remove the statutory restrictions to allow CMS to distribute savings for each program, said Keely Macmillan, a senior vice president at Archway Health in Boston, in a video interview this week with Peter Wehrwein, senior editor of Managed Healthcare Executive®, and Briana Contreras, the associate editor.

“How they address the overlap will depend on what they find in their analysis,” Macmillan said. “I would hope and expect that in doing this CMS would gather stakeholder input and input from actual participants in this model."

The Value in Health Care Act will make adjustments to various MACRA (Medicaid Access and CHIP Reauthorization Act) programs and models launched by CMS. The legislation was introduced in the House two Democrats, Suzan Delbene of Washington State and Peter Welch of Vermont, and a Republican, Darin LaHood of Illinois.

Macmillan said she expects there to be a sponsor in the Senate soon.

“The provider community has been hit really hard by this national emergency and there is a strong need and desire to help providers continue to provide services,” she said.

High-profile, influential groups have come out in support of the legislation, including the American Medical Association, the American Hospital Association, and the American College of Physicians. The trade association for ACOs, the National Association of ACOs, is also supporting the bill.

Macmillan said the legislation is designed to make participation in the CMS Advanced Alternative Payment Models more attractive. One of the key provisions would keep the bonus for participating in the models at 5% of a provider’s Medicare B payments for an additional six years. It is currently scheduled to drop to .75%.

“A 5% bonus on all of your [Part B] Medicare fee for service revenue is significant and by extending that for six year — that is a real financial incentive,” Macmillan told Wehrwein and Contreras, nothing that the legislation would also lower the threshold for providers to become eligible for the bonus.