Bipartisan Letter Requests Extended Value-Based Payment Incentives

More than 40 House lawmakers have asked congressional leaders to support value-based payment incentives and extend the 5 percent bonus for Alternative Payment Model (APM) participation.

In a bipartisan letter sent to House Speaker Nancy Pelosi and Minority Leader Kevin McCarthy, the House members emphasized how the APM incentive payments help providers shift from fee-for-service to value-based care models.

The Medicare Access and CHIP Reauthorization Act (MACRA) introduced the incentive payment to encourage healthcare practices to transition into APMs, where providers are held accountable for the quality and cost of patient care.

The bonus allows providers to reduce cost-sharing and invest in social determinants of health initiatives such as transportation and meal programs and care coordination.

However, the incentive payment is set to expire at the end of 2022 if Congress does not act. According to the letter, the expiration would negatively impact nearly 300,000 clinicians and slow growth in future APM participation.

In addition, rural and underserved communities would have fewer opportunities and face more barriers to value-based payment models.

“We’ve learned this 5 percent incentive is a key driver to moving more providers into value-based payment models. In the Medicare Shared Savings Program, half of ACOs are taking on financial risk today, compared to less than 10 percent in 2017 when the incentives first became available,” Clif Gaus, ScD, president and chief executive officer of the National Association of ACOs (NAACOS), said in a press release.

“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.”

ACOs saved Medicare $3.6 billion in 2021, which is significantly higher than the $613 million offered in 2022 APM incentive payments.

“It’s clear that MACRA’s 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 House members wrote.

The letter specifically requested that Congress include Section 4 of the Value in Health Care Act in an end-of-year legislative package. The legislation would extend the 5 percent incentive payments and allow CMS to adjust qualifying thresholds.

The request from House lawmakers follows several letters from healthcare organizations pushing for extended value-based payment incentives.

In September, more than 800 ACOs and healthcare associations, including NAACOS and the American Medical Association (AMA), asked congressional leaders to pass the Value in Health Care Act.

Recently, NAACOS and the American Medical Group Association (MGMA) sent letters to House members urging them to extend the APM bonus, among other requests that would support value-based care participation.