Preserving Patient Access to Accountable Care Act
- Sponsor
- Rep. LaHood, Darin [R-IL-16]
- Committees
- Ways and Means Committee (primary)
- Last action
- Jan 28, 2025
Bottom line
This bill aims to encourage continued participation in value-based care models by extending financial incentives for Medicare providers for one more year.
What it actually does
This bill extends the period for incentive payments to healthcare providers participating in eligible alternative payment models (APMs) under the Medicare program. Specifically, it extends the 3.5% incentive payment for an additional year, through 2027, and makes conforming amendments to related provisions concerning physician fee schedule updates to align with this extension.
Proponents argue
Supporters argue that extending these incentive payments is crucial for stabilizing and strengthening the transition to value-based care models, which reward quality and cost-efficiency over volume. They contend that without this extension, many providers, especially smaller practices, might disengage from APMs, hindering efforts to improve patient outcomes and control Medicare spending in the long run.
Opponents contend
Critics might argue that continuing these incentive payments without a clear demonstration of their long-term effectiveness or a more sustainable funding mechanism adds to Medicare's financial burden. They may contend that these incentives should be phased out as APMs mature, or that the program should be reformed to ensure that incentives are more directly tied to measurable improvements in patient care and cost savings.
The bill is very short and its core provisions are easily understood, allowing for quick evaluation.
Section 2(a)
Extension of Incentive Payments for Participation in Eligible Alternative Payment Models
This provision amends Section 1833(z) of the Social Security Act to extend the 3.5% incentive payment for participation in eligible Alternative Payment Models (APMs) under the Medicare program. Originally set to expire with 2026, this bill extends the incentive payment through 2027. It also adjusts the payment percentage for 2027 to 3.53% for certain calculations, maintaining the financial encouragement for providers to engage in value-based care.
Supporters argue
Supporters argue that extending these payments is vital to prevent providers from exiting APMs, which are designed to improve care coordination and outcomes while reducing costs. They believe this continuity supports the long-term transformation of the healthcare system towards value-based care.
Critics contend
Critics might argue that continuing these incentives indefinitely without a clear exit strategy or proof of significant return on investment could be fiscally irresponsible. They may suggest that providers should be incentivized by the inherent benefits of APMs rather than relying on additional payments.
Tradeoffs
The bill balances the immediate financial support for providers transitioning to value-based care against the long-term fiscal sustainability of the Medicare program. It aims to prevent disruption in APM participation while incurring additional federal expenditure.
Section 2(b)
Conforming Amendments to Physician Fee Schedule Updates
This section makes technical adjustments to Section 1848(q)(1)(C)(iii) of the Social Security Act, which governs updates to the Medicare physician fee schedule. These amendments align the dates for certain payment adjustments, specifically extending the period during which the physician fee schedule update is modified for those not participating in APMs, to correspond with the extended APM incentive payments. This ensures consistency across Medicare payment policies.