AMGA Advocates to Congress on Future Medicare Pay Cuts, APM Payments

Feb. 15, 2023
The leaders of AMGA, which represents the nation’s largest multispecialty groups, on Wednesday asked leaders in Congress to address Medicare payment-cut and APM-payment concerns

The leaders of the Alexandria, Va.-based AMGA (American Medical Group Association), which represents more than 175,000 physicians practicing in multispecialty medical groups and caring for one in three Americans, on Feb. sent a letter to the leaders of the U.S. Congress asking Congress to better incentivize the path to value-based payment going forward.

A press release posted to the association’s website began thus: “AMGA today recommended Congress support providers' transition to value-based care by implementing a stable Medicare payment system and modernizing telehealth coverage policies. In a letter to congressional leadership, AMGA called on Congress to develop a more sustainable system that enables providers to continue to provide the highest quality care to their patients.”

The press release quoted Jerry Penso, M.D., MBA, the association’s president and CEO, as stating that “AMGA is thankful for Congress’ efforts to ensure access to care by providing essential resources and regulatory stability throughout the COVID-19 public health emergency. However, potential Medicare cuts, workforce shortages, historical inflation, and the fallout from the COVID-19 pandemic are creating additional burdens on providers and patients. Congress has the opportunity to evaluate and improve the Medicare program to support providers in their efforts to offer the best possible care to their patients in a value-based delivery system,” Dr. Penso said.

The press release went on to say that, “In the letter, AMGA recommends that Congress provide a pathway to value in Medicare by improving and incentivizing value-based models of care. These recommendations include extending the 5-percent Advanced Alternative Payment Model incentive payments, investing in infrastructure, incentivizing patient engagement, and promoting end-of-life care. Regarding telehealth, AMGA urges Congress to acknowledge how the pandemic has altered care delivery and take the following actions: permanently waiving geographic limitations and originating site regulations; ensuring payment parity between in-office and telehealth services; continuing payment for audio-only services; and removing state licensing restrictions for telehealth services.”

Further, the press release noted, “AMGA also recommended that Congress continue to support the Medicare Advantage program, promote health equity, ensure provider access to administrative claims data, and eliminate the coinsurance payment requirement for chronic care management.”

The letter, addressed to Rep. Kevin McCarthy (R.-Calif.), Speaker of the House of Representatives, Sen. Chuck Schumer (D-N.Y.), Senate Majority Leader, Rep. Hakeen Jeffries (D.-N.Y.), House Minority Leader, and Sen. Mitch McConnell (R.-Ky.), Senate Minority Leader, began thus: “Dear Speaker McCarthy, Leader Schumer, Minority Leader Jeffries, and Minority Leader McConnell: On behalf of AMGA and our members, I appreciate the opportunity to outline our priorities as you begin your legislative session. Additionally, we thank you for your continued support of healthcare organizations throughout the novel coronavirus (COVID-19) pandemic. Your leadership ensured that multispecialty medical groups and integrated systems of care throughout the country received the funding, resources, and flexibilities needed to treat the communities they serve. Although the state of the COVID-19 pandemic has evolved since 2020, the overall impact of this public health emergency (PHE) continues to have significant long-term repercussions for the healthcare system. As the PHE ends, Congress must ensure that the necessary infrastructure is in place so AMGA members can continue to provide the highest quality care to their patients.”

The letter addressed the four leaders, stating that: “As you begin the 118th Congress, we wanted to make recommendations on several key issues impacting multispecialty medical groups and integrated systems of care and the communities they serve: Sustain the Medicare program and provide a pathway to value; improve and incentivize value-based models of care; invest in infrastructure; incentivize patient engagement; promote end of life care; promote telehealth; preserve Medicare Advantage; promote health equity; ensure provider access to administrative claims data; improve care for the chronically ill.”

Under the heading “Sustain the Medicare program and provide and pathway to value,” the letter went on to note that, “For the past two years, providers faced close to 10 percent cuts in Medicare reimbursement. In December 2021 and 2022, Congress intervened by delaying some of these cuts. Due to the most recently passed Consolidated Appropriations Act of 2023, most of these detrimental reductions were postponed until December 31, 2024. While AMGA members are grateful for the relief, continued Medicare cuts, workforce shortages, historic inflation, and the ongoing strain due to the COVID-19 pandemic are creating an additional burden on providers and patients. Continual concern about looming catastrophic cuts to reimbursement, like last year’s potential 10-percent reduction, precludes investments in the transition to value-based care. A more sustainable system needs to be developed and adopted so medical groups can continue to care for their communities.”

Two specific requests in AMGA’s letter center on averting Medicare physician payment cuts and on the provision of advanced APM (alternative payment model) payments.

With regard to Medicare cuts, the AMGA leaders wrote in the letter that, “For the past two years, providers faced close to 10-percent cuts in Medicare reimbursement. In December 2021 and 2022, Congress intervened by delaying some of these cuts. Due to the most recently passed Consolidated Appropriations Act of 2023, most of these detrimental reductions were postponed until December 31, 2024. While AMGA members are grateful for the relief, continued Medicare cuts, workforce shortages, historic inflation, and the ongoing strain due to the COVID-19 pandemic are creating an additional burden on providers and patients. Continual concern about looming catastrophic cuts to reimbursement, like last year’s potential 10% reduction, precludes investments in the transition to value-based care. A more sustainable system needs to be developed and adopted so medical groups can continue to care for their communities.”

And, under the heading, “Improve and incentivize value-based models of care,” the AMGA leaders noted that, “Last August, the Centers for Medicare & Medicaid Services (CMS) announced that the Medicare Shared Savings Program (MSSP) saved the Medicare program $1.66 billion. This marked the fifth consecutive year the MSSP has generated overall savings compared to expected Medicare expenditures. The success of the MSSP demonstrates the importance of the 5-percent Advanced Alternative Payment Model (APM) incentive payment. When the Medicare Access to CHIP Reauthorization Act of 2015 (MACRA) was enacted, it set in motion a transition to value-based Medicare physician payment. Part of the law created a 5-percent Advanced APM payment, which incentivized providers to move toward value-based models. Eligibility to earn incentive payments was set to expire at the end of 2022, but Congress intervened in the Consolidated Appropriations Act of 2023, which extended the bonus payment for an additional year but at a lower 3.5-percent rate. We ask that you continue to invest in value and create a more stable Advanced APM program that sends a clear signal to providers that this transition to value has the support of federal policymakers.”

The full text of the letter can be found here.

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