Congress should direct $50 billion of COVID-19 relief funding to primary care, rural and safety-net hospitals, with some of the money tied towards participation in alternative payment models, several non-partisan advocacy groups said.
The proposal from Families USA and United States of Care, as well as the Margolis Center for Health Policy, comes as Congress debates whether to allocate more help for providers in the next COVID-19 relief package. The groups said Congress should use this opportunity to address long-standing issues on how providers are paid, which have been exacerbated as COVID-19 has caused hospital and physician volumes to plummet.
“The way providers are paid has led to these financial crises,” the groups said in a statement. “Fee-for-service payment has been criticized for encouraging volume over value; now organizations are also finding that FFS offers no backstop when utilization drops in a public health emergency.”
So the groups are pushing Congress for a total of $50 billion to be directed towards supporting payment reform.
From the $50 billion new fund, the proposal would allocate $35 billion to help providers that increase the use of alternative payment models.
“By the end of 2023, providers receiving resilience payments must increase the share of payments they receive from public and private payers through [alternative payment models] by at least 20 percentage points with larger increases for bigger shifts,” according to a release on the proposal.
Another $15 billion would go towards providers who have taken steps this year and in 2021 to combat the impact of the pandemic.
Measures of response should include rapid electronic data sharing, meaningful collaboration with public health initiatives and a commitment to value-based and alternative payment models.
Congress has approved $175 billion in provider relief funding and Health and Human Services has doled out more than $110 billion to providers. HHS has given targeted distributions to safety-net providers, rural providers and facilities in COVID-19 hotspots. But that money is not tied to participation in value-based care or alternative payment models.
The Centers for Medicare & Medicaid Services has made some changes to value-based care programs to help preserve participation. These include extending deadlines for submitting quality data for some of the value-based care programs.
The agency also extended the Next-Gen Accountable Care Organization model through 2021, which is for ACOs that take on higher financial risk. ACOs agree to meet certain healthcare spending targets and get any share of savings but must repay Medicare for not meeting the targets.
CMS also paused signups for new ACOs for 2021.
It remains unclear if the proposal could be included in the next congressional relief package.
So far, Congress and the White House have not reached a deal for a new package. The House a few months ago passed the HEROES Act, which gives $100 billion to providers, but the package has stalled in the GOP-controlled Senate.
A package introduced by Senate Majority Leader Mitch McConnell would give $25 billion to providers and extent liability protections from lawsuits.