November 19, 2020
. – Nineteen leading healthcare organizations today called on Congressional leaders to ensure that providers who put themselves at financial risk to deliver better quality, closely coordinated and more cost-effective care continue to have strong incentives to engage in advanced value-based care models.
In enacting the bipartisan Medicare Access and CHIP Reauthorization Act (MACRA), Congress established a bonus to encourage providers to participate in Advanced Alternative Payment Models (APMs) where they shoulder a significant level of financial risk and are accountable for the quality of care. Clinicians that achieve threshold levels of payments or patients through Advanced APMs are eligible to earn a 5 percent Medicare bonus payment.
“The incentive payments established under MACRA have served as an important tool for attracting clinicians to leave traditional fee-for-service and adopt risk-based models that are focused on lowering costs and improving quality,” wrote the organizations.
In 2021, however, both the revenue and patient participation thresholds for the advanced APM bonus are scheduled to increase sharply. Currently, to qualify for the 5 percent bonus clinicians must have 50 percent of payments or 35 percent of patients in an advanced APM. In 2021, the threshold jumps to 75 percent of payments or 50 percent of patients. These higher thresholds would cause many clinicians in APM arrangements with significant risk to lose out on bonus payment moving forward.
Organizations representing clinicians, medical groups, health systems and other provider groups sent a letter
to House and Senate leaders urging them to freeze the MACRA advanced APM thresholds at the 2020 levels for the next two performance years.
Encouraging providers in risk-bearing APMs to remain engaged and other clinicians to join advanced APMs is particularly critical given the ongoing public health emergency.
“Providers operating in APMs have been able to leverage existing community relationships and aligned networks of providers across the continuum to develop comprehensive approaches to maintain the health of the community and treat patients with COVID-19,” states the letter. “If we had made more progress in value-based care APMs prior to COVID-19, including risk-based and capitated arrangements, many providers could have avoided the financial challenges they faced.”
Clinicians and other providers in advanced APMs are innovating care while reaping savings for the Medicare program. Most recently, CMS announced that ACOs participating in the Medicare Shared Savings Program have achieved savings for the Medicare program for three consecutive years, achieving an all-time high of $1.19 billion in total net Medicare savings
in 2019. Moreover, 92 percent of these ACOs earned reward points for improving the quality of care for their patients.
The letter was signed by Aledade, American Academy of Family Physicians, American College of Physicians, American Hospital Association, American Medical Association, American Medical Group Association, American Society for Radiation Oncology, America’s Essential Hospitals, America’s Physician Groups, Association of American Medical Colleges, Caravan Health, Evolent Health, Federation of American Hospitals, Health Care Transformation Task Force, Medical Group Management Association, National Association of ACOs, Next Gen ACO Coalition, Premier healthcare alliance, and Renal Physicians Association.