The American Hospital Association is advocating for value-based care as the House of Representatives seeks input on modernizing the Medicare Access and CHIP Reauthorization Act of 2015, a Jan. 16 letter said.
The organization stressed the importance of alternative payment models, but it said member hospitals sometimes struggled to implement Center for Medicare & Medicaid Innovation initiatives. AHA said legislative reforms should focus on these elements in models:
- Appropriate on-ramp and glidepath to transition to risk
- Adequate risk adjustment
- Voluntary participation and flexibility
- Balanced risk versus reward
- Guardrails to prevent hospitals from competing with their own top performance
- Upfront investment incentives
- Transparency
- Adequate model length
- Waivers to address barriers
AHA also said incentives for advanced alternative payment models were put on the back burner due to lower participation and identified it as another area for improvement, along with investment in rural hospitals.
“These models are often not designed in ways that allow broad rural participation, and the AHA supports continued efforts to better support rural hospitals’ migration to Advanced APMs,” the letter said.
Another concern: Metrics.
“The AHA believes that rigorously designed, clinically relevant cost measures can help provide insights into the value of care that clinicians deliver,” the organization said. “At the same time, we have long been concerned with these measures’ limited actionability, extraordinary complexity, questionable reliability and rushed implementation.”
AHA advocated for consensus-based entity endorsement of all cost measures used in the merit-based incentive payment system, along with reevaluation of attribution methodologies and consideration of upstream risk factors.
The letter also included ideas for supporting accountable care organizations, specifically regarding their transitions to risk and low- versus high-revenue designations. AHA pushed for conversion factor updates, as well, to accommodate economic shifts.
“We would encourage more sustainable, real-time approaches to updating the conversion factor in line with inflation. Annual conversion factor updates should be made to reflect changes in input costs and inflation,” the letter said. “This will support physicians’ ability to transition to APMs.”
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