On Dec. 29, 2022, President Biden signed the Consolidated Appropriations Act, 2023 (H.R. 2617) into law. It includes $1.7 trillion in fiscal year 2023 discretionary government funding for all 12 annual spending bills, as well as a number of other health care provisions.With billions going to healthcare, what are our industry leaders saying about how the money will be spent? We reach out to see what they had to say.
We greatly appreciate Congress including a 3.5 percent value-based care incentive in a year-end spending bill. NAACOS and others have been calling on lawmakers to extend these critical incentives so that our health system can maintain momentum on its value-based care movement. Care for millions of patients will be better off because the health system is rewarding doctors for providing higher quality care at lower cost.
While this is not the full 5 percent that providers have been receiving and NAACOS asked for, it does maintain some incentive to keep the momentum while Congress works on a long-term solution to encouraging adoption of alternative payment models. This should be considered a bridge toward greater reforms needed to encourage providers’ move into accountable care organizations. Without additional carrots and sticks, doctors and hospitals will continue to be stuck in a volume-driven, fee-for-service payment system that discourages keeping patients healthy and out of the hospital. Instead, we need more patients and providers in value-based models, and the next Congress will play a critical role in work to overhaul our physician payment system.
The increase in reimbursement will be certainly welcomed by providers. However, that increase will be wiped out by the pursuit of maximizing codes without demonstrating the patient care that has been provided to support those codes and the resultant fines and sanctions that follow. The more money that enters the Medicare system, the higher the scrutiny for the care provided.
As an industry, health care has been trying to move away from fee for service reimbursement models for almost 20 years. Follow the money. It won’t happen without direct financial incentives that support delivery of the right care, in the right setting, at the right time. This 3.5% incentive and investment is another step in the right direction that has been recognized by Congress as a priority, as the nation continues to adopt value based payment models that are necessary for population health efforts.
In an environment of significant cost pressures, a partial extension of value-based care incentives for providers – down from 5 percent to 3.5 percent, but not eliminated – is an important, but partial win for providers, patients, and the overall sustainability of the US healthcare system. As we look to innovative models to advance healthcare delivery and improve healthcare outcomes, aligning incentives is one of the greatest policy tools at our disposal. Until we fully embrace and incentivize the adoption of value-based care, we will largely be stuck with the inefficiencies of a fee-for-service system to the detriment of all us who participate in it.
The $1.7 trillion omnibus spending bill was a positive for telehealth users as it extended several key provisions for the next two years, expanding the ability to provide and pay for virtual care services. First it extends critical Medicare telehealth flexibilities, including waiving originating site requirements, delaying the in-person visit requirement before receiving mental health services, allowing reimbursement for audio-only telehealth and allowing telehealth for acute hospital-level care at home. Second, it extends the safe harbor that allows employers to offer telehealth on a pre-deductible basis for their employees in High Deductible Health Plans (HDHPs) with Health Savings Account (HSAs). This two-year extension will hopefully provide enough time for Congress to see how critically important virtual care options are for improving access and quality across our healthcare system, and then to create more permanent solutions that ensure telehealth can be used more easily and fairly across our country.
With the impending likelihood of the Public Health Emergency ending in April, the Omnibus provisions surrounding the April 1 redetermination process for states could not have come at a better time. This will afford a more structured and methodical approach to Medicaid and CHIP enrollment. I am hopeful states and providers will plan appropriately to execute a transitional plan for the estimated 15M enrollees that will be impacted.
Diversifying and modernizing clinical trials, specifically by implementing more technology where necessary, decentralizes these trials by nature, thereby expanding patient access and participant diversity. Clearer guidelines from regulatory bodies can help with standardizing the decentralized clinical trial space. This, in turn, will allow the industry to expand and larger stakeholders, such as Walgreens, CVS, Walmart and others, to move in.
The omnibus bill passed at the end of last year continues the prohibition on funding for the adoption of a unique patient identifier. Without a UPI, healthcare will continue to be plagued by duplicate patient records and record overlays, which are wasteful and even dangerous. Health organizations, from labs to hospitals, should continue to invest in measures that prevent, identify and correct these records.
The omnibus bill passed at the end of last year takes several steps to improve the government’s ability to prepare for health emergencies. If Covid-19 taught us anything, it is the importance of accurate and reliable data to informed decision-making. While healthcare has no shortage of data, it must do more to ensure the data is trustworthy. It can do this by investing in technology that better collects, protects and analyzes information, while avoiding errors.
With the passing of the 2023 Omnibus Bill, we know that millions of Medicaid members will be at risk of lapsing their Medicaid coverage if they do not take action to renew starting in April of this year. Additionally, with the drop in the value-based care bonus, many providers may need additional support to remain financially sustainable and continue caring for the most at-risk members of the community. It’s going to be crucial that payers, providers, community-based organizations, and state governments link arms to ensure that we aren’t accelerating health disparities as part of this shift.
Lawmakers are trying to have it both ways, but in the current environment, it’s difficult for healthcare providers to live in the duality of value-based care (VBC) and fee-for-service reimbursement models. Instead of making serious and substantive changes to the healthcare payment model, legislators continue to kick the can down the road with the ebb and flow of support and incentives that seem to vary year after year. It’s time for lawmakers to pick a specific strategy and get behind it.