The Medicare Payments Advisory Committee believes that new models with different risk trajectories and administratively set savings benchmarks could be the way forward for alternative population-based payment models, although committee members noted at Friday’s meeting that there are still many details to work out.

Commissioner Brian Debske, chief executive of medical device maker DeRoyal Industries, said at Friday’s meeting that MedPAC should advise Congress to consider timeliness and simplicity.as Medicare Advantage Grows Each year, population-based alternative payment models such as Responsible Care Organization He added that the number of remaining beneficiaries is dwindling.

In October, MedPAC commissioners discussed developing a single, multi-track, population-based payment model to guide CMS’ strategy for alternative payment models. CMS set a Target In the same month, include all Medicare beneficiaries in value-based payment arrangements by 2030.

MedPAC is followed by discussion in november With regard to setting the administratively set benchmark for the ACO, beneficiaries can share in Medicare savings if their spending falls below a specified benchmark level. The benchmark is based on the spending of beneficiaries eligible for ACO in the base year and the increase in ACO spending between the base year and the performance year.

Because ACO benchmarks are reset every performance cycle based on ACO’s past performance, ACOs that increase their annual savings will have to deal with increasingly difficult benchmarks, putting long-term ACO participation at risk.

MedPAC staff on Friday provided commissioners with a blueprint for a hypothetical new three-track alternative payment model. The model divides providers into three distinct categories.Independent physician practices, small safety net providers, or rural providers may be in a situation that does not involve any Financial risk. Suppliers can keep up to 50% of the savings generated relative to their benchmark after reaching the minimum savings rate.

Mid-sized organizations such as multi-specialty clinics or small community hospitals can save up to 75% or repay 75% of losses. Large health systems will use a 100% shared savings or loss rate.

Dr. Jonathan Jaffery, the commissioner in charge of the UW Health ACO, questioned whether an organization’s size should determine its level of risk readiness. Large organizations may struggle to access shared savings when the cost of care is lower, he said, and smaller organizations are sometimes more flexible than larger organizations.

Also worth discussing is how quickly suppliers should be pushed to accept financial risk. Small suppliers could be allowed to stay on the risk-free track indefinitely, or eventually be encouraged to move to another track.

Commissioner David Grabowski, a professor at Harvard Medical School, said downside risks should not be imposed on suppliers, while Commissioner Dana Gelb Safran, president and CEO of the National Quality Forum, said bilateral risks could allow Suppliers are serious about saving money.

Getting providers involved in such models in the first place is another hurdle MedPAC wants to clear.Incentives for providers to participate in APM are written decreeMedPAC staff say that by 2040, senior APM physicians will be paid 8% higher than physicians who choose not to participate.

But to encourage more participation, officials could simply force certain providers to accept the Medicare-funded model. Other options include paying lower fees to clinicians not participating in the model, waiving certain health insurance requirements for participants, and providing participants with more technical assistance.

Setting dates for future mandatory participation for at least mid-sized and large organizations may help boost participation in the short term, said Dr. Lawrence Casalino, a professor at Weill Cornell University’s Graduate School of Medical Sciences.

“When payment reform is my job, one of the things I hear a lot is how important it is to have a clear signal of where things are going,” agreed Safran. “That must have been a very clear signal.”

The hypothetical model will also use external factors to administratively benchmark the ACO to account for ratcheting effects. Most commissioners applauded the idea.

“Eliminating the ratchet effect is absolutely critical. As long as there is a problem with the ratchet, the ACO program cannot work,” Casalino said.

But Commissioner Lynn Barr, head of Caravan Health, who guides providers through value-based care, expressed concern that changing the system would cause providers to generate less savings and ultimately have to pay back the government.

Paul Ginsburg, a senior fellow and vice chair of the Schaeffer Health Policy Initiative at USC Brookings, said MedPAC should assume that legislation is needed to implement the alternative payment model reforms the committee is seeking.

“We don’t want to lock ourselves into 2010 regulations where there is much less experience with these payment methods,” he said.