DHPA President Dr. Michael Weinstein testified before the U.S. House Energy & Commerce Health Subcommittee during a hearing entitled “Examining Barriers to Expanding Innovative Value-Based Care in Medicare.”
Dr. Weinstein testified that expanding Alternative Payment Models (APMs) to independent practices will enable health care to move to a more cost-efficient setting. Dr. Weinstein urged Congress and the Centers for Medicare and Medicaid Services (CMS) to help level the playing field for independent physician practices, improve care coordination, cut costs and promote value-based health care delivery through targeted policy changes.
In his testimony, Dr. Weinstein argued that Congress and CMS can improve the system to develop, evaluate and approve alternative payment models by allowing providers to test an APM while it Is being developed. Currently, the Medicare statute permits the Health and Human Services Department to waive the Stark and other fraud and abuse laws on a case-by-case basis only for approved APMs. Weinstein also testified that access to ready and affordable utilization data is needed to model and develop such innovative payment arrangements.
Dr. Weinstein called for the Stark Law to be modernized to encourage more independent physician participation in developing APMs. This same waiver authority was provided to accountable care organizations (ACOs) under the Affordable Care Act. Independent practices must be able to incentivize appropriate physician behavior for adherence to recognized treatment pathways, otherwise it’s hard for Medicare to promote value-based care if physicians are explicitly prohibited from paying for value.
In addition, Dr. Weinstein requested support for the Medicare Care Coordination Improvement Act, H.R. 4206, which would enact many of the improvements that would encourage a robust, competitive health care market and dramatically increase physician participation in value-based care.
Click here to read Dr. Weinstein’s full witness statement.