In late June, the House Ways and Means Subcommittee on Health held a hearing on value-based care and ways to improve it. The hearing featured witnesses from various health care organizations who are familiar with value-based care models, which pay physicians based on patient outcomes. They also talked more broadly about administrative burdens, access to care, the cost of implementing these value-based programs, and other health care-related burdens.
Value-based care
Subcommittee members expressed hope that value-based care is the future of the health care system, but there seemed to be a consensus among members and witnesses that the CMS Innovation Center (CMMI) has dropped the ball. Members expressed concern with CMMI’s attempt to create new and perfect models, when they can modify and improve their existing value-based care models. Members also asked about the easiest ways to reform CMMI, and witnesses suggested that reforming the fee schedule, rather than CMMI itself, would be the easiest action to take in the short term.
Members and witnesses talked about how readmissions are a key problem in pay-for-performance models in areas that have a more complex patient base. One congressman expressed hopes that nurse practitioners will be able to enroll patients in accountable care organizations (ACOs), as they are currently unable to do so. There is hope among members that value-based care can help rural areas, and that technological advancements can help identify problems before people need to go to emergency rooms. There were also concerns about hospitals charging for extra services to make up for increased overhead.
Medicare Advantage
Members discussed Medicare Advantage (MA), saying that MA costs 22% more than traditional fee-for-service Medicare and has problems with inappropriate coverage denials.
Private equity
A congresswoman asked about how private equity firms jeopardize the quality of care for patients. The witnesses responded saying it can often cost Medicare more money. They also emphasized that financial pressures lead to poor staff ratios and suboptimal organization for quality care. One witness hoped that HHS would mandate staffing ratios.
Rural health
One member observed that in rural areas, fewer providers are enrolled in value-based care models than in more populated areas. The witnesses explained that the administrative burdens are incredibly hard, considering the high demand of care that those providers face.
Conclusion
Overall, this hearing touched on many of the issues associated with successfully administering value-based care but extended into other administrative burdens facing physicians as well. We expect these types of hearings to continue no matter which party controls the House after the November election. They create awareness and encourage dialogue on the topics.
The Advocacy Council – ADVOCATING FOR ALLERGISTS AND THEIR PATIENTS.
