As Healthcare Value Week continues, it is important to highlight what aspects of Medicare's Alternative Payment Models (APMs) are working for medical groups and what areas need improvement to incentivize greater participation.
A January 24, 2023, MGMA Stat poll asked medical groups if Medicare done enough to incentivize practices to adopt value-based care? The majority (93%) answered “no.”
As a follow-up, the poll asked what is more effective, positive or negative incentives? The majority (87%) said positive incentives, while only 11% responded “negative,” and another 2% said both.
The poll had 424 applicable responses.
- In MGMA’s 2022 Annual Regulatory Burden Report, 61% of surveyed medical group practices stated they would be interested in participating in an APM. However, 78% indicated that there is not a clinically relevant APM currently available for practices to participate in.
- An MGMA Stat poll from January 2020 found that only 19% of medical group practices participated in APMs.
- MGMA Stat polling from March 2018 found almost 3 out of 4 (72%) of medical group leaders were opposed to mandatory participation in Medicare APMs.
Since the Medicare Access & CHIP Reauthorization Act (MACRA) was signed into law in 2015, the Centers for Medicare & Medicaid Services (CMS) has attempted to move away from fee-for-service (FFS) and transition to value-based care. MGMA has long supported the development of voluntary APMs and has urged CMS to eliminate barriers to physician participation to advance value-based care. CMS should offer appropriate support, flexibility, and incentives while developing well-designed APMs for all specialties that offer stability and transparency.
The APM 5% incentive payment was set to expire at the end of 2022, but the Consolidated Appropriations Act (CAA), 2023, extended the bonus for an additional year but lowered it to 3.5% instead of 5%. While MGMA is happy our advocacy efforts helped stop the complete discontinuation of this incentive payment, it is critical Congress reinstate the full 5% to realize the potential of APMs. MGMA members have seen positive results from participating in APMs, but have detailed that this incentive payment was essential to their success. Offering other positive incentives and flexibilities such as upfront investments, resources, and tools would only further practice participation.
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