On Oct. 19, the House Energy and Commerce Subcommittee on Health held a hearing to examine physician payment policies and proposed legislative solutions to increase beneficiary access to care.
The committee examined legislative policies to further the goals of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which replaced the Sustainable Growth Rate formula that had been used to determine Medicare payments to physicians but consistently threatened severe payment cuts. MACRA introduced two payment tracks for clinicians: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).
One of the main topics of discussion concerned the use of MIPS versus APMs. Among the two panels of witnesses questioned during the hearing, Meena Seshamani, M.D., Ph.D., director of the Center for Medicare at the Centers for Medicare & Medicaid Services (CMS), expressed the agency’s interest in implementing the MIPS Value Pathways Program as a means of driving participation in values-based care, rather than fee-for-service.
According to one of the witnesses on the second panel, Joe Albanese, senior policy analyst at Paragon Health Institute, APMs have been costly. During the first 10 years, operating APMs has cost more than $5 billion, rather than saving $3 billion as expected. Albanese went on to explain that in Medicare Advantage, there is a similar structure to APMs for population-based payments and passing on savings to beneficiaries and enrollees with lower cost-sharing. These payment models deliver core Medicare benefits at 83 percent of the cost.
Additionally, the Strengthening Medicare for Patients and Providers Act (H.R. 2474) was among the several pieces of legislation that was either alluded to or specifically mentioned during Thursday’s hearing. H.R. 2474 would amend title XVIII of the Social Security Act to provide for an update to a single conversion factor under the Medicare Physician Fee Schedule that is based on the Medicare economic index.
The full hearing live stream can be found on the Energy and Commerce committee website.
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