Bill introduced to avoid 5% cuts to APM incentives for value-based care

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Funding changes could affect 300,000 clinicians, millions of patients.

Senators have introduced legislation to avoid a looming 5% cut to physicians receiving reimbursements for using value-based care models.

The Preserving Access to Value Based Care Act would extend 5% advanced alternative payment models (APMs) for two years. Currently the incentive-based payments will expire at the end of 2022, a change that could affect an estimated 300,000 clinicians and potentially millions of patients.

The legislation also “ensures that qualification thresholds remain at attainable levels for practices that participate in Medicare’s advanced APMs,” said an announcement by Sen. John Barrasso, MD, R-Wyoming.

“As a doctor, I know how critical it is for Medicare to meet the health care needs of American seniors,” Barrasso said in the announcement. “There is agreement on both sides of the aisle that alternative payment models (APMs) are a key solution to help more seniors receive better care at a lower cost.


“Our bipartisan legislation will ensure this incentive program continues to help provide the highest quality care for seniors across the country,” said Barrasso, who introduced the bill with Sen. Sheldon Whitehouse, D-Rhode Island.

“Rhode Island’s accountable care organizations have been national leaders at improving patient care and lowering costs,” Whitehouse said in the statement. “Medicare has earned back millions from their success. We need to encourage more health care innovation – not pull the rug out from under the people who are making the system work better for everyone.

“There is strong bipartisan support for our proposal to allow these providers to continue delivering high-quality coordinated care,” Whitehouse said.

Along with physician payments, the expiring incentives would jeopardize patient care, according to the National Association of ACOs (NAACOS). That group represents and supports physicians, practices and health care organizations participating in accountable care models.

About 300,000 clinicians receive the 5% incentives on their Medicare payments, with risk-bearing ACOs being the dominant method of securing the payments. If the incentives expire, it would discourage future participation in accountable care models, so millions of patients could lose access to value-based care, according to NAACOS.

Congress will be playing with fire by not extending these critical incentives, which are important to providing patients and our health system with better outcomes and higher quality care,” NAACOS President and CEO Clif Gaus, ScD, said in a news release. “We realize that there are several competing priorities for lawmakers but hope they recognize the critical role value-based care providers play in improving our health system. We thank Sen. Barrasso and Sen. Whitehouse for their leadership.”