Providers Praise Bill Introduced to Extend APM Incentive Payments for Two More Years

Dec. 15, 2022
Providers are expressing satisfaction over the introduction of a bipartisan bill that would extend APM incentive payments to providers for an additional two years

On Wednesday, Dec. 14, two senators, a Republican and a Democrat, introduced a bill into the Senate that would extend incentive payments for providers participating in alternative payment models (APMs) for an additional two years, responding to calls from patient care organization leaders participating in APMs, including in accountable care organizations (ACOs) for an extension of such incentives beyond the public health emergency (PHE), which is set to sunset soon.

A press release posted on Tuesday announced the legislative move by Sens. John Barrasso (R-Wyo.) and Sheldon Whitehouse (D.-R.I.). It began thus: “Today, U.S. Senator John Barrasso (R-Wyo.) and U.S. Senator Sheldon Whitehouse (D-R.I.) introduced the Preserving Access to Value Based Care Act. This bipartisan legislation ensures health care providers through Medicare continue to commit to value-based models, or Alternative Payment Models (APMs). This program reimburses providers for the quality of care, rather than the number of services they provide. Physicians who participate in APMs overwhelmingly agree that value-based care delivers high quality care.”

The press release went on to note that “This bill will extend the five percent advanced APM incentive payment for providers for an additional two years. The bill also ensures that qualification thresholds remain at attainable levels for practices that participate in Medicare’s advanced APMs. This incentive-based payment is set to expire at the end of 2022 if Congress does not extend the program.”

And it quoted both senators. “As a doctor, I know how critical it is for Medicare to meet the health care needs of American seniors. 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,” Sen. Barrasso said. “Our bipartisan legislation will ensure this incentive program continues to help provide the highest quality care for seniors across the country.” “Rhode Island’s accountable care organizations have been national leaders at improving patient care and lowering costs. Medicare has earned back millions from their success,” Sen. Whitehouse said. “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.”

The bill was immediately praised by the leaders of organizations involved in ACOs and APMs. “These critical incentives Congress created, which expire at the end of the year, have been instrumental to fuel the transition to value-based care, which provides patients and our health system with better outcomes and higher quality care, Clif Gaus, Sc.D., president and CEO of the Washington, D.C.-based National Association of ACOs (NAACOS) said in a statement contained in the press release.

And Jack Resneck Jr., M.D., president of the American Medical Association (AMA), was quoted in the press release in stating that “With each passing year, it becomes more urgent to provide physicians with greater opportunities to participate in Alternative Payment Models (APMs) when they can improve quality and value for patients while reducing burdens on physicians and practices. While it’s also important to maintain a viable fee-for-service option, the burdensome Merit-based Incentive Payment System (MIPS) contributes to physician burnout by requiring physicians to annually spend about $12,800 and more than 200 hours of staff time on compliance instead of patient care. A robust set of APMs is crucial to alleviating this burden. We applaud Sens. Whitehouse and Barrasso for this common-sense bill to extend the APM incentive payments for two years and permit physicians to gradually increase their degree of participation in value-based care models,” he added.

Meanwhile, Susan Dentzer, president and CEO of APG, America’s Physician Groups, said in a statement that “America’s Physician Groups lauds Senators Whitehouse and Barrasso for introducing bipartisan legislation to extend the critically-needed Medicare incentive payments to clinicians participating in Advanced Alternative Payment Models. Approximately 300,000 physicians and other clinicians engaged in these models use the five percent bonuses on the Medicare physician fee schedule to build the systems needed to better coordinate care for patients. The incentives have been particularly useful for drawing more specialists into value-based payment arrangements. It is important not to interrupt this transition process, and extending the bonuses for another two years, as this legislation would do, will help maintain the momentum for providing more patient-centered, value-based care for those enrolled in the traditional Medicare program.”

And Jerry Penso, M.D., president and CEO of AMGA, the American Medical Group Association, endorsed the legislation, saying that “The Advanced APM program is critical in Medicare’s continued transition to value. This bill ensures that Medicare offers the support providers need to start and continue the journey to value. Passage of this bill sends a clear signal that value is here to stay in the Medicare program.”

Ashley Ridlon, vice president of health policy at the New York-based Evolent Health, whose division Evolent Care Partners manages 1,500 providers across nine states involved in their Medicare Shared Savings Program (MSSP) ACO, says the issues addressed in the new bill are of tremendous interest to providers, in terms of their continued participation in APMs. “We are seeing physicians, particularly primary care physicians, really struggle,” Ridlon says. “There are 4.5-percent cuts coming next year. I worked on Capitol Hill during the era of the SGR cuts, and this is all of a sudden feeling like that.” The bigger picture here, she says, is “physician payment sustainability. We would argue that this 5-percent advanced payment needs to be a part of physician payment. We believe that if Congress addresses physician payment, value needs to be a part of the equation. And the bonus has been effective; we’ve seen ACOs grow significantly. But as of today, only 20 percent of physicians have qualified for the bonus. So it has fallen short of expectations.”

Ultimately, Ridlon says, “We’d like to see at least a couple of more years of having this help incent provider participation. We’ve already recruited providers for 2023. And in 2023, we’d be able to say to providers, join this model and you can qualify for the bonus in 2024.”

Sponsored Recommendations

2024's Healthcare Buyer Journey: New Research and Insights

Join us on April 30th for a webinar unveiling insights from the latest study on the Healthcare IT Buying Journey! Discover evolving challenges, effective health data management...

Improving care with AI-powered solutions

Don't miss our April 23rd webinar delving into the transformative impact of AI-powered solutions on healthcare. Join industry leaders Reid Conant and Dr. Patrick McGill as they...

Shield your health system against cyber threats

You won't want to miss out on this imperative April 4th webinar about how you can protect your healthcare organization. Join us to learn how to fortify your health system against...

Healthcare Trends 2024: Trends & Strategies for Future Success

Explore the future of healthcare in 2024 with insights from the Healthcare Industry Trends Report. Stay ahead of the curve as we delve into the latest industry developments and...