Providers urge Congress to act quickly on COVID-19 assistance, value-based payment

• Hospitals are urging the lame-duck Congress to add more money to a pandemic-related assistance fund.
• Hospitals also seek statutory language to prevent certain regulations on those funds.
• Providers are urging changes to allow more physicians to garner Medicare bonuses over the next two years.

Provider groups are ramping up pressure on Congress to act on several priorities during its post-election lame-duck session, although the outcome remains unclear.

In a Nov. 19 letter, the Federation of American Hospitals (FAH) urged congressional leaders to appropriate an unspecified additional amount of COVID-19 financial assistance. The Trump administration has distributed most of the $175 billion previously appropriated to the Provider Relief Fund (PRF), and hospitals say the ongoing wave has further weakened their finances.

With “the number of COVID-19 cases and hospitalizations skyrocketing and the number of legislative days dwindling before the 116th Congress adjourns, we strongly urge Congress to break the gridlock and provide much-needed additional relief,” wrote Chip Kahn, president and CEO of FAH. “The nation’s hospitals and caregivers will not relent until this pandemic is over, but we need help from Congress now.”

Anne Marie Scotto, practice team assistant for Holland & Knight, said she was confident Congress will increase the available amount of PRF grants but was less certain about whether legislators would do so this year or in 2021.

“They’re going to try [this year]. Whether they get something done is unclear to me,” said Scotto, who provides legal services for hospitals.

FAH, which represents more than 1,000 for-profit hospitals and health systems, also urged the inclusion of language to combat regulatory rules that it has opposed regarding PRF distributions. Specific changes sought by the association include:

• Permitting providers to calculate and report on lost revenues by “any reasonable method,” including comparing budgeted and actual revenues
• Permitting health systems to redeploy funds among their eligible hospitals based on where funds are most needed

Other funding provisions sought

Other FAH priorities, as stated in the letter, include:

• Funding expiring extenders in Medicare, Medicaid, CHIP and other programs through Sept. 30, 2021
• Eliminating cuts to the Medicaid Disproportionate Share Hospital (DSH) program
• Providing funding for personal protective equipment
• Providing liability protections for healthcare professionals and facilities
• Barring surprise medical bills “while ensuring a fair process for providers and payers to negotiate payment rates”

Whether any of those priorities advance in the current Congress may depend on the type of larger legislative vehicle to which supporters will try to attach them. Congress will need to extend federal government funding, which is set to expire Dec. 11, but the type and timing of that extension may limit underlying provisions.

“The question is, is it a super-skinny kick-the-can [bill], or is it really comprehensive?” Scotto said. “It wouldn’t surprise me if it is something in between where they don’t solve all of the world’s problems, but they get money out to the people who really need it.”

Value-based payment model changes sought

Another Nov. 19 letter from 19 hospital, physician and value-based payment (VBP) organizations to congressional leaders urged lowering the VBP participation thresholds required for physicians to garner a 5% increase in Medicare payments for performance year 2021.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) provided a 5% bonus on Part B payments if physicians met increasing thresholds of participation in advanced alternative payment models (APMs). In 2020, the thresholds are 50% of payments or 35% of patients in the advanced APM. In 2021, the thresholds increase to 75% of payments or 50% of patients.

“As we enter the fifth year of incenting clinicians to move to APMs, we now understand that the original thresholds set in MACRA are too high,” the organizations wrote.

CMS issued an Oct. 28 report on 2018 MACRA participation rates that found 59% of 874,515 eligible clinicians will not qualify for the bonus.

“Moreover, the COVID-19 pandemic has made it more challenging to achieve the thresholds,” the groups wrote. “Advanced APMs have proven to generate savings to Medicare and in the absence of these bonuses, we believe many clinicians will exit from APMs and revert to fee-for-service.”

The groups urged Congress to freeze the thresholds at the current levels for the 2021 and 2022 performance years.

“This would ensure clinicians currently participating in risk-bearing APMs will continue to receive bonus payments and encourage other clinicians to join advanced APMs,” the groups wrote.