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Lawmakers urge extension of incentives for joining APMs


Letter to Congressional leaders says ending payments would discourage APM participation and development of new payment models

With a financial incentive for participation in advanced alternative payment models (APMs) due to expire soon, a bipartisan group of lawmakers and a coalition of health care organizations are gearing up to preserve it.

In a November 2nd letter, 44 U.S. House of Representatives members from both parties urged their leaders to keep the 5% additional incentive payments doctors get from Medicare for moving from fee-for-service payments to an APM. The incentives, which were included in the 2015 Medicare Access and CHIP Reauthorization Act (MACRA), are scheduled to end at the end of this year.

“One of the primary goals of MACRA was to encourage healthcare providers to transition away from fragmented, fee-for-service payment systems into APMs where providers are accountable for the quality and cost of care,” the letter states. Allowing the incentives to expire would “negatively impact nearly 300,000 clinicians who care for millions of Medicare beneficiaries and slow growth in future participation” and “would limit opportunities for rural and underserved communities whose health care providers may need more support to transition to innovative care delivery models.”

The letter asks for Congress to extend the incentive payments by including Section 4 of the bipartisan Value in Health Care Act in a year-end legislative package, adding that the legislation would “allow CMS [the Centers for Medicare and Medicaid Services] to adjust qualifying thresholds to achievable levels in the coming years. These policies would continue the responsible push toward innovation and coordination in healthcare and improving health outcomes.”

The lawmakers’ letter follows a similar one from more than 800 physician and health care associations, health systems, provider practices and ACOs sent to leaders of both the House and Senate at the end of September. It notes that accountable care organizations, which are the most common type of advanced APMs, spend on average between $1 million and $2 million on advanced care delivery tools such as care coordinators, data analytics and quality measurement systems.

“The Advanced APM incentive payments undoubtedly help them afford some of these investments, allowing them to reinvest in care transformation initiatives to benefit patients,” according to the letter.

Both letters stress the financial and care quality benefits of APMs, pointing to the estimated $2.1 billion in net savings generated by ACOs in 2020, along with improved patient outcomes compared to fee-for-service practices. “It’s clear that…investments in value-based care have provided a strong return for the government that can continue providing savings in the future, while encouraging the kind of proactive, coordinated health care delivery that patients want and deserve,” the lawmakers’ letter says.

The National Association of ACOs (NAACOS

)commended the representatives for their support for extending the financial incentives. “We’ve learned this 5 percent incentive is a key driver to moving more providers into value-based payment models,” NAACOS President and CEO Clif Gaus, Sc.D. said in a statement. “We know advanced alternative payment models improve patient outcomes and experience by giving physicians and other providers tools to innovate and better coordinate care. These providers deliver higher quality care at lower costs.”

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