Healthcare Snapshot

August 2023

Reps. DelBene, LaHood, Schrier, Wenstrup, Blumenauer, and Bucshon Introduce the Value in Health Care Act of 2023

Several U.S. Representatives came together in July to introduce a bipartisan bill that to support greater participation in Medicare Alternative Payment Models (APMs). Reps. DelBene, LaHood, Schrier, Wenstrup, Blumenauer, and Bucshon are proposing several changes, including the extension of the 5% incentive payment for Advanced APM Participants.

In her press release, DelBene stated "Physicians and hospitals participating in Alternative Payment Models are leading the changes our health care system needs to focus on value instead of volume. The Value in Health Care Act would encourage more providers to join these models and accelerate this change, leading to improved quality of care and health outcomes for seniors."

Key changes included in the Value Act are:

• Increased percentage of shared savings for beginner participants.
• Modifies risk adjustment to be more realistic and better reflect factors participants encounter like health and other risk variables in their communities.
• Removes barriers to ACO participation by eliminating arbitrary program distinctions so all participants are participating on a level playing field.
• Supports fair and accurate benchmarks by modifying performance metrics so participants aren’t competing against their own successes in providing better care.
• Provides greater technical support to ACO participants to cover the significant startup costs associated with program participation.
• Incentivizes participation in Advanced APMs by extending the annual lump sum participation bonus for an additional two years.
• Corrects arbitrary thresholds for Advanced APM qualification to better reflect the existing progress of the value-based movement and to encourage bringing more patients into this model of care.

Click here to view the Value Act or view the summary of the bill by the Alliance for Value-Based Patient Care.

A patient was recently receiving care from a Skilled Nursing Facility (SNF) when they had a fall while attempting to transfer themselves into a wheelchair without any assistance. This resulted in an intercranial hemorrhage, and the patient being transferred to a nearby hospital. 

The PSW Care Management Team was notified of the beneficiary’s scheduled return to the SNF a few days later. PSW’s Director of Post Acute reviewed the documentation to determine the interventions completed by the neurosurgeon. The Director noticed that the recommendations in the neurosurgeon’s notes and the discharge summary from the hospitalist said to hold the use of Eliquis. They also noticed that the notes did not describe how long the hold should be in place or when Eliquis should be restarted, even though Eliquis was listed on the discharge summary medication list. 

Luckily, a provider from the patient’s attributed practice regularly joins Care Team meetings that PSW holds to review patient interventions and was willing to follow-up to figure out if there was a discrepancy or if the Primary Care Provider needed to get involved right away. The provider contacted the SNF where the patient had been discharged and identified that the documentation they received stated that Eliquis was an active medication. The provider then contacted the hospital and was able to learn about notes in the Electronic Health Record (EHR) that stated the hold would be for 5-7 days and the patient should be on a temporary does of Keppa for seizure prophylaxis. This also had not been included on the transfer orders.

Thanks to the early intervention of PSW’s Care Management Team and the work of the partnering provider, the MD at the SNF was able to access the EMR, view the information provided by the neurosurgeon, and change the orders to follow the neurosurgeon’s recommendations. This coordination of care allowed for the medication ordering error to be found and resolved before severely affecting the patient.