Washington, D.C. – Today, U.S. Representatives Darin LaHood (IL-16), Suzan DelBene (WA-01), Brad Wenstrup (OH-02), Kim Schrier (WA-08), Larry Bucshon, M.D. (IN-08), and Earl Blumenauer (OR-03) reintroduced the Value in Health Care Act, a bipartisan bill that will make commonsense changes to the program parameters of Medicare’s Alternative Payment Models (APMs) to incentivize participation in Accountable Care Organizations (ACO). The changes will increase participation in these value-based health programs that are designed to improve the quality of care and health outcomes for seniors while lowering costs.
“The Value in Health Care Act is a commonsense proposal that includes substantive reforms to encourage and support greater participation by healthcare providers in ACO’s, particularly in our rural communities in Illinois,” said Rep. LaHood. “By incentivizing the use of these value-based health models that support coordinated care between doctors, hospitals, and other healthcare providers, this legislation will improve healthcare access and the quality of care for seniors and patients across my district.”
“Physicians and hospitals participating in Alternative Payment Models are leading the changes our health care system needs to focus on value instead of volume. The Value in Health Care Act would encourage more providers to join these models and accelerate this change, leading to improved quality of care and health outcomes for seniors,” said Rep. DelBene. “Shifting to value will also save everyday people and our health system money in the long-term. We must continue to provide the incentives that expand access to coordinated and comprehensive care.”
“As a physician, I know how important it is that we are valuing positive patient outcomes over the sheer volume of services provided. This legislation will help improve health care access and quality for seniors, particularly in rural communities, by encouraging more providers to participate in value-based health programs and coordinating care between hospitals, physicians, and health care providers,” said Rep. Wenstrup.
“The Value in Health Care Act is an effort to make our health care system more efficient and create an environment where providers are rewarded for transitioning to ways of providing healthcare that don’t compensate based on numbers of visits or procedures, but based on patient outcomes, " said Rep. Schrier, M.D. "This bill incentivizes coordinated and value-based care for our seniors by expanding access for Medicare patients. It has proven to save billions of dollars for taxpayers while improving care, and is exactly the type of pragmatic, bipartisan legislation that we can move through this Congress.”
“Having been a practicing heart surgeon for over 15 years, I believe it’s critical we continue working to move our health care system away from simply reimbursing health care providers based on volume – like a commodity – to reimbursing providers for providing quality care that achieves positive outcomes for patients,” said Rep. Bucshon, M.D. “I believe this legislation will help us ensure that more health care providers – especially independent practice and rural providers – can easily participate in Medicare’s value-based and coordinated care programs, which will improve access to quality care for seniors.”
“For too long, our health care system has prioritized volume over value,” said Rep. Blumenauer. “This is unsustainable for providers, patients, and the federal government. It is time we move toward a future that lowers costs while maintaining high-quality care for patients.”
Alternative Payment Models (APM) have played a key role in providing high-quality care for Medicare beneficiaries while producing billions of dollars in savings for taxpayers in the past decade. However, rules implemented to the Accountable Care Organizations (ACO) programs have limited the number of providers participating. The Value in Health Care Act helps maintain and further strengthen the movement towards value where financial performance is linked to the quality of patient care rather than the number of services delivered.
“By promoting enhanced coordination between hospitals, doctors and other healthcare providers, this collaborative approach to value-based healthcare will improve beneficiaries’ quality of care and, ultimately, health outcomes,” said A.J. Wilhelmi, Illinois Health and Hospital Association, President & CEO. “I’d like to thank Rep. LaHood for advancing this sensible, patient-focused initiative.”
“More than a decade of experience shows us that value-based care is improving patient outcomes, delivering high quality care at lower costs, while maintaining important patient protections. Accountable care organizations alone have saved Medicare more than $17 billion while improving quality. The Value in Health Care Act would maintain incentives to bring more providers into value-based care models and expand access for beneficiaries. This important piece of legislation should be part of Congress’s conversation to update physician payment. We thank Reps. LaHood, DelBene, Wenstrup, Blumenauer, and Schrier for their leadership on this issue," added Clif Gaus, Sc.D., President and CEO of the National Association of ACOs.
“The Value Act establishes important priorities in advancing health care delivery that drives health outcomes over the volume of services provided. MACRA established incentives to drive the transformation from fee- for-service to accountable care because a broad, bipartisan group of lawmakers knew America’s health care delivery system must improve to meet people’s needs. The pandemic demonstrated we need innovation in health care more than ever before, yet progress is threatened by incentives that will expire at the end of this year. The Value Act ensures this investment in people’s health continues for two more years. Accountable for Health and its members look forward to working with Representatives LaHood and DelBene to advance this bill and continue transforming American health care away from fee-for-service toward high quality, accountable care," added Mara McDermott, CEO, Accountable for Health.
“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 alternative payment models (APMs). The American Medical Association applauds Reps. Darin LaHood (R-IL), Suzan DelBene (D-WA), Brad Wenstrup (R-OH), Earl Blumenauer (D-OR), Bucshon (R-IN), and Kim Schrier (D-WA), for introducing the Value in Health Care Act," said Jesse M. Ehrenfeld, M.D., M.P.H. President, American Medical Association.
The Value in Health Care Act would make the following changes to the APM and ACO parameters:
- Provides a multi-year commitment to reforming care delivery by extending MACRA’s 5 percent advanced APM incentive payments for 2 years to continue to encourage the movement to value
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Establishes guardrails for CMS to ensure that the process to set financial benchmarks is transparent and appropriately accounts for regional variations in spending to prevent arbitrary winners and losers.
- Removes barriers to ACO participation by eliminating arbitrary program distinctions so all participants are participating on a level playing field.
- Supports fair and accurate benchmarks by modifying performance metrics so participants aren’t competing against their own successes in providing better care.
- Provides greater technical support to ACO participants to cover the significant startup costs associated with program participation.
- Incentivizes participation in Advanced APMs by extending the annual lump sum participation bonus for an additional two years.
- Corrects arbitrary thresholds for Advanced APM qualification to better reflect the existing progress of the value-based movement and to encourage bringing more patients into this model of care.
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