AAFP Urges Congress to Strengthen Value-based Care Support

Detailed Guidance Builds on Recent APM Incentive Win

March 7, 2023, News Staff — The AAFP recently urged Congress to take several specific steps toward advancing value-based care and improving Medicare physician payment.

The letter — co-signed by 11 other medical and health care groups, including the Association of American Medical Colleges, the American College of Physicians and the AMA — pointed out that the move away from fee-for-service health care intended by the bipartisan Medicare Access and CHIP Reauthorization Act “remains below original projections.” Though value-based payment reforms “have generated some $17 billion in gross savings for Medicare over the last decade and improved the quality of care for millions of patients,” the groups said, only about 30% of Medicare clinicians participate in risk-based payment models so far.

To ensure sufficient resources for the approximately 300,000 clinicians “working to improve the quality and cost-effectiveness of care for millions of Medicare beneficiaries through APMs” — and to attract more physicians to such models — the Academy and its co-signatories recommended that lawmakers

• further extend MACRA’s advanced APM incentive payments and restore the rate to 5%;
• allow CMS to adjust APM participation thresholds and set varying thresholds for certain models in which participants would otherwise be unable to meet existing thresholds;
• ensure recruitment and retention in existing APMS by removing distinctions that create barriers to participation for safety-net clinicians;
• improve financial methodologies so APM participants are not penalized for their own success;
• reduce regulatory burdens and patient costs by offering increased flexibilities and waivers for clinicians; and
• work with the CMS Innovation Center to ensure that promising models have a more predictable implementation pathway for being implemented and becoming permanent, and are not cut short due to overly stringent criteria.

“Additionally, Congress should encourage more multi-payer value-based arrangements and examine how APM incentive payments and shared savings payments, which are incorporated into Medicare Advantage benchmarks, are equitably passed on to physicians and other clinicians,” the letter said.

The Academy also reminded Congress that increasing Medicare fee-for-service payment remains a necessary step to advancing value-based care.

“Stabilizing Medicare’s payment system and ensuring payment adequacy will also help physicians invest in the infrastructure and staffing necessary to transition into value-based models,” the letter said. “We encourage your committees to hold hearings and engage with stakeholders to consider long-term approaches for advancing value.”

The counsel reiterated points the Academy made last year in calling for reintroduction of the Value in Health Care Act of 2021, a bipartisan bill meant to strengthen Medicare’s value-based care models and Accountable Care Organizations.