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The Value in Health Care Act of 2023: What does it mean for providers?
September 6, 2023
A bipartisan group of lawmakers proposed key changes to the Value in Health Care Act of 2021 and Medicare’s alternative payment models (APMs). Should the bill pass, the impact on providers could be significant: the legislation would increase the percentage of shared savings participants receive, modify program risk adjustment and performance metrics, strengthen technical support for participants, and extend the annual lump sum participation bonus for an additional two years. (O’Reilly, 2023).
What is the Value in Health Care Act of 2023?
H.R. 5013, a successor to the Value in Health Care Act of 2021, further reinforces Medicare’s transition from a fee-for-service to a value-based care (VBC) model. The Act incentivizes providers and healthcare organizations to adopt VBC models and join accountable care organizations (ACOs) that provide quality care while reducing unnecessary healthcare spending. (Anderson, 2023; Contreras, 2023).
The Value in Health Care Act has broad support among major associations and healthcare organizations, including the American Academy of Family Physicians, American Medical Association, and American Hospital Association. (O’Reilly, 2023)
What are the key changes in the legislation and how do they impact providers?
The bill includes the following key measures:
- Extend the bipartisan Medicare Access and CHIP Reauthorization Act (MACRA) incentive payments for providers who take on increased financial risk through advanced APMs. These payments, which began in 2015, are slated to expire at the end of 2023, but H.R. 5013 would extend the 5% payments by 2 years. The incentives have historically been paid to providers who earn a certain proportion of their revenue or see a certain percentage of their patients from VBC models. (O’Reilly, 2023)
- Modify the thresholds used to qualify participants for advanced APM payments. MACRA established uniform performance thresholds that disadvantage some providers. The proposed Act would allow the Centers for Medicare and Medicaid Services (CMS) the authority to adjust performance thresholds in such a way that rural, underserved, primary care, or specialty practices can qualify. (O’Reilly, 2023; Anderson, 2023)
- Provide additional technical support and infrastructure investments for ACOs, small practices, clinicians, and other providers who serve rural or medically underserved populations. Transitioning from a fee-for-service to VBC model can be costly; this support would lessen the burden to providers and healthcare organizations. (Anderson, 2023)
- Ensure all providers can participate on equal footing by removing outdated, arbitrary Medicare Shared Savings Program (MSSP) distinctions. Historically, CMS varied MSSP policies based on an ACO’s revenue status. This led some ACOs to avoid partnering with certain provider types and disadvantaged rural and safety net providers. H.R. 5013 would eliminate these revenue-based distinctions and ensure that high performers are encouraged to participate regardless of provider type and would allow providers to more effectively collaborate in ways that best meet the needs of their patients. (Contreras, 2023; O’Reilly, 2023)
Sources:
118th Congress. (2023, July 27). H.R. 5013 – Value in Health Care Act of 2023. https://www.congress.gov/bill/118th-congress/house-bill/5013
Anderson, M. (2023, Aug 24). Healthcare Brew. The Value in Health Care Act aims to incentivize providers to participate in value-based care models. https://www.healthcare-brew.com/stories/2023/08/24/the-value-in-health-care-act-aims-to-incentivize-providers-to-participate-in-value-based-care-models
Contreras, B. (2023, July 29). Managed Healthcare Executive. Value in Health Care Act of 2023 Introduced to Congress to Reinforce Value-Based Care. https://www.managedhealthcareexecutive.com/view/value-in-health-care-act-of-2023-introduced-to-congress-to-reinforce-value-based-care
O’Reilly, K. (2023, Aug 21). American Medical Association. New bipartisan bill a crucial boost to Medicare value-based care. https://www.ama-assn.org/practice-management/payment-delivery-models/new-bipartisan-bill-crucial-boost-medicare-value-based
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