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Tweaking value-based health care delays real reform

July 29, 2020

Topics: Quote of the Day

The Value in Health Care Act aims to increase APM participation by extending incentives and correcting arbitrary qualification standards under MACRA and the Medicare Shared Savings Program.

By Jacqueline LaPointe

A bipartisan bill introduced late last week aims to increase alternative payment model (APM) participation by making “commonsense changes” to the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.

Specifically, the Value in Health Care Act seeks amendments to many program parameters of Medicare’s APMs, including MACRA’s Advanced APM pathway and the Medicare Shared Savings Program (MSSP). Among the changes would be a six-year extension of the 5 percent incentive payment for Advanced APM participants and lower thresholds for Advanced APM participation from 75 percent to 50 percent of Medicare patients in performance year 2021.

HHS would also be able to increase the threshold by no more than 5 percent each performance year under the bill.

The bill also intends to increase accountable care organization (ACO) participation in the MSSP by increasing shared savings rates for shared savings-only ACOs. The levels would be at least 50 percent for ACOs in Levels A and B of the BASIC track and 55 percent for those in Levels C and D.

The shared savings rate would be at least 60 percent for ACOs in Level E.

Also, the bill would modify risk adjustment to allow for a greater score increase and adjust benchmarking to remove ACO beneficiaries from the regional reference population under regional benchmarking.

Additionally, the bill would eliminate the high-low revenue distinction implemented during an overhaul of the MSSP in 2018. If passed, all ACOs in the program would be subject to low revenue policies, according to the legislation.

The changes would incent participation in the models, while accelerating the transition to value-based care, Representatives Suzan DelBene (D-WA), Peter Welch (D-VT), and Darin LaHood (R-IL) said.

Signed into law in 2015, MACRA established a value-based reimbursement system for Medicare providers. The law created the Quality Payment Program, which includes the Merit-Based Incentive Payment System (MIPS) and the Advanced APM pathway.

While most Medicare providers participate in the Quality Payment Program via MIPS, policymakers intend for the program to ramp up participation in APMs through the Advanced APM pathway.


“Value in Health Care Act of 2020”:

Association between specialist compensation and Accountable Care Organization performance

By Ishani Ganguli, MD, MPH; Claire Lupo, BBA; et al
HSR Health Services Research, July 27, 2020


To determine if Medicare Shared Savings Program Accountable Care Organizations (ACOs) using cost reduction measures in specialist compensation demonstrated better performance.


Incentivizing specialists on cost reduction was not associated with ACO savings in the short term. Further work is needed to determine the most effective approach to engage specialists in ACO efforts.



By Don McCanne, M.D.

The policy community, with the support of the politicians, has been fixated on MACRA, ACO, MSSP, MIPS, APM, P4P, etc., etc. as a means of achieving value-based health care. So far the results have been very unimpressive, though some reports claim that the approach is about to show some benefit, so they wish.

As an example of how inadequate this approach is, the HSR study shows that incentivizing specialists has not been associated with ACO savings. If it is not working for specialized services, then it is not working, period.

Now the “Value in Health Care Act of 2020” is being introduced to provide some tweaks to the system in an effort to increase participation in these payment models. If you read the proposed legislation you will see that it will likely have very little net impact, but it will have been effective in further delaying truly beneficial reform such as the single payer model of Medicare for All. Sometimes it seems as if that is their primary goal after all.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

About the Commentator, Don McCanne

Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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