AMGA urges Congress to extend value-based care incentives, prevent pay cuts

The American Medical Group Association (AMGA) has urged congressional leaders to ensure provider stability by incentivizing value-based care, preventing additional Medicare payment cuts, and preserving the Medicare Advantage program.

While Congress has made strides to improve Medicare Part B reimbursement and extend value-based program incentives, AMGA has recommended additional policy actions to help multispecialty medical groups maintain care delivery.

The group has asked leaders to prevent further Medicare payment cuts. Over the past four years, providers have faced an almost 8 percent reduction in Medicare Part B reimbursement. Congress has passed partial, temporary patches to the conversion factor, but more help is needed.

If heftier Medicare Part B cuts are implemented in 2025, providers risk being furloughed or laid off, eliminating services to Medicare patients, and delaying social determinants of health investments.

The American Rescue Plan Act of 2021 triggered the Pay-As-You-Go (PAYGO) rules, creating a 4 percent annual cut to the Medicare program. Congress has delayed the PAYGO reductions for the last three years, but policymakers must address the issue by December 31, 2024. AMGA urged leaders to prevent the proposed cuts to maintain access to care for Medicare patients.

The Value in Health Care Act proposed to extend the 5 percent Advanced Alternative Payment Model incentive payments for another two years and revise policies in the Medicare Shared Savings Program (MSSP) to facilitate participation. The letter recommended that Congress further extend the incentive payment program and implement reforms to the MSSP by approving the legislation.

AMGA opposed changes in the Advance Notice of Methodological Changes for Calendar Year 2024 for Medicare Advantage Capitation Rates and Part C and Part D Payment Policies. The group had recommended against changing the Hierarchical Condition Categories model, believing that it would not address coding variation and would remove clinical differences from the model. The removal of codes would also impact providers’ financial stability and patient access to services, AMGA said.

The group asked Congress to carefully consider any Medicare Advantage policy changes to ensure they do not negatively impact care. Additionally, the letter urged leaders to extend the waiver of Medicare’s telehealth originating site and geographic limitations and implement permanent waivers to maintain parity between in-office, telehealth, and audio-only visits.

AMGA recommended Congress pass the Pharmacy Benefit Manager Reform Act, which would require commercial payers to provide claims data to providers, facilitating data exchange between all stakeholders involved in patient care. In addition, the group requested legislation that waives the current chronic care management code coinsurance requirement for Medicare beneficiaries.