New Bill Intended to Increase Physician Participation in APMs

The American Medical Association (AMA) has urged Congress to make key changes to the recently introduced Value in Health Care Act that will encourage increased physician participation in alternative payment models (APMs). With its introduction by a bipartisan group of legislators, and support from the AMA, the additional physician participation the bill may help generate could be integral to improving patient care while creating cost savings for Medicare.

According to AMA President, Jesse M. Ehrenfeld, M.D., M.P.H., a senior associate dean, tenured professor of anesthesiology and director of the Advancing a Healthier Wisconsin Endowment at the Medical College of Wisconsin, “The movement toward value-based care—designing payment models to support quality and coordination of patient care rather than the number of services delivered—is gaining momentum. We must build on that progress with more investment in these models and ensure that physicians in all specialties can be active participants in APMs.” 

He added, “This crucial bipartisan bill will continue the 5 percent APM incentive payments for two years and freeze the 50 percent revenue threshold that physicians in value-based care models must meet to qualify for these bonuses over the same time frame.” 

Within the Value in Health Care Act, key provisions include:

·      Authorizing the Centers for Medicare & Medicaid Services (CMS) to establish lower APM participation thresholds for episode models and other types of APMs that, by definition, involve a lower percentage of a practice’s patient population.

·       Eliminating revenue-based distinctions within Medicare’s Accountable Care Organization (ACO) Program, which affects certain rural and safety net providers’ share in the savings they earn and often forces them to accept greater levels of financial risk at a more rapid pace.

·       Establishing enhanced transparency to ensure that CMS sets appropriate spending benchmarks that don’t penalize ACOs for their own success.

·       Creating a voluntary, full-risk model option for Medicare ACOs.

·       Providing additional technical support, including infrastructure investments, from HHS for ACOs, small practices, physicians, or other providers that serve rural or medically underserved populations. 

·       Requiring the Government Accountability Office to produce a study evaluating potential parity between APMs and Medicare Advantage payment policies, flexibilities and financial benchmarks. 

A letter in support of the Value in Health Care Act was signed by the AMA, as well as 17 other national healthcare organizations. The letter pointed out, “In the last decade, some APMs have generated billions of dollars in savings for taxpayers all while maintaining quality of care for patients.” The letter also applauds the bill for providing a “multiyear commitment to reforming care delivery,” which will allow healthcare to move away from a one-size-fits-all approach.