Provider Coalition Asks Congress to Extend APM Incentive Payments

The leaders of more than 550 healthcare organizations and 24 leading healthcare associations on May 29 wrote a letter to the top leaders of the two political parties in Congress, urging them to preserve incentive payments in Advanced Alternative Payment Models (APMs) under Medicare, in whatever final bill emerges out of Congress in the 2026 federal budget legislation, in order to avert their sunsetting. The signatories are calling on Congress to extend incentive payments and halt impending policy changes that threaten to derail progress. As the leaders of NAACOS—the Washington, D.C.-based National Association of Accountable Care Organizations—noted in a press release on May 29, “APMs have already saved Medicare over $28 billion while improving patient outcomes. Without legislative support, providers—particularly in underserved areas—face financial instability and increased regulatory burdens that could compromise care quality.”

The letter, dated May 29, 2025, and whose entire text appears on the NAACOS website, was addressed to House Speaker Mike Johnson (R.-La), House Minority Leader Hakeem Jeffries (D.-N.Y.), Senate Majority Leader John Thune (R-S.D.), and Senate Minority Leader Chuck Schumer (D.-N.Y.). It began thus: “Dear Speaker Johnson, Leader Thune, Leader Jeffries, and Leader Schumer: On behalf of the 24 undersigned physician and health care associations and more than 550 accountable care organizations (ACOs), health systems, hospitals, physician practices, health clinics, and accountable care stakeholders we call on Congress to support continued investment in Medicare’s transition to advanced APMs that take on accountability for costs and outcomes of their patient populations. APMs reduce health care spending and improve outcomes by providing physicians, hospitals, and other health care providers with incentives and tools to manage patient populations proactively. APMs focus on management of chronic conditions and reward prevention across the continuum of care. This approach has proven successful with Medicare as ACOs, the largest APM in Medicare, lowered spending by more than $28 billion over the last decade. Physicians and other health care providers in ACOs also consistently outperformed clinicians in nonvalue-based payment models on quality measures, including preventive care measures,” the healthcare leaders emphasized.

“Moreover,” they wrote, “these reforms have produced a spillover effect that improves care and lowers costs for patients across the health care system. Medicare’s transition to advanced APMs was made possible by the financial incentive payments and regulatory flexibility that Congress included in the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The incentive payments and exemptions from costly regulatory burdens helped drive participation in advanced APMs with more than 500,000 clinicians now participating and bearing downside financial risk for their Medicare patients3 and 53.4 percent of beneficiaries with Traditional Medicare now in an accountable relationship with their clinician.”

Importantly, the healthcare leaders wrote, “The advanced APM incentive payments allow physicians, hospitals, and other health care providers to cover the upfront and ongoing investments necessary to improve patient outcomes and expand services not covered by traditional Medicare. Incentive payments help fund wellness programs, patient transportation, meal programs, cost-sharing support for beneficiaries, and expanded access to care coordinators.”

What’s more, the healthcare leaders wrote, “While we have seen steady growth for advanced APMs in recent years, 2025 is a pivotal year for Medicare’s value transformation. The expiration of Medicare’s advanced APM incentive payments and sharp increase in qualifying thresholds is creating significant challenges for physician practices and hospitals as they plan for the years ahead. The financial uncertainty reduces the capacity of practices to manage complex patients, particularly in rural and underserved areas. The sharp increase in advanced APM qualifying thresholds will involuntarily push more clinicians back into the Merit-based Incentive Payment System (MIPS) program, which will mean more physician practices and hospitals will have to incur higher costs and regulatory burdens associated with MIPS reporting.”

As a result, the letter’s signatories wrote, “We urgently ask lawmakers to continue supporting the movement to value-based care by prioritizing the extension of Medicare’s advanced APM incentive payments and stopping the drastic increase in qualifying thresholds, as called for in the bipartisan bicameral Preserving Patient Access to Accountable Care Act (H.R. 786/S. 1460). Addressing these critical issues as soon as possible will ensure that physicians, hospitals, and other health care providers have the resources and regulatory certainty needed to support beneficiaries’ continued access to high quality, patient-centered care.”

The full text of the letter, including the list of its signatories, can be found here. The