Health care organizations urge Congress to continue APM incentives

A broad coalition of physician groups and health care organizations is calling on Congress to continue incentives for participating in advanced alternative payment models (APMs) that include financial risk.

In a letter to leaders of the Senate and U.S. House of Representatives, 23 physician and health care associations and more than 600 health systems, hospitals, physician practices, health clinics and accountable care organizations asked legislators to extend the 5% incentive payments for APM participation that were part of the 2015 Medicare Access and CHIP Reauthorization Act (MACRA). The incentives are due to expire at the end of 2023.

“The advanced APM incentive payments have allowed clinicians to cover some of the investment costs of moving to new payment models, including expanding care teams, developing programs to improve beneficiary care, and adopting population health infrastructure,” the letter states. “Incentives also help to improve care for patients by giving clinicians financial resources to expand services beyond those covered by traditional Medicare.”

It also calls the advanced APM incentives “a good return on investment,” citing the $1.8 billion in savings in 2022 generated by accountable care organizations (though which many practices participate in APMs) resulting from the $644 million paid in incentives. It points to Congressional Budget Office data showing that 2022 federal spending on Medicare and Medicaid was 9% lower than originally projected, with improved care management and more efficient technology use—hallmarks of APM participation—among the factors responsible for the lower spending.

“APMs have demonstrated that when physicians…. are held accountable for costs and quality and provided flexibility from fee-for-service constraints, they can generate savings for taxpayers and improve beneficiary care,” the letter states.

The letter warns that failure to continue the incentives would stall the transition to value-based care by increasing the likelihood of clinicians remaining in MACRA’s Merit-based Incentive Payment System, a program it calls “burdensome” and one that “presents participants with financial costs associated with compliance and quality assurance measures, and does little to accurately assess improvements in health care outcomes.”

Among signatories to the letter are the American College of Physicians, the American Academy of Family Physicians, the American Osteopathic Association, the Medical Group Management Association and the Primary Care Collaborative.