Medical providers, hospitals call on Congress to extend 5% value-based care incentive

The push for value-based payment incentives continues, as more than 630 organizations sent a letter last week urging Congressional leaders to extend incentive payments for participation in risk-bearing alternative payment models (APMs). Incentives expire at the end of the year unless Congress acts.

“The advanced APM incentive payments have allowed clinicians to cover some of the investment costs of moving to new payment models, including expanding care teams, developing programs to improve beneficiary care, and adopting population health infrastructure,” states the letter, which was addressed to Senate Majority Leader Chuck Schumer (D-N.Y.), Senate Minority Leader Mitch McConnell (R-Ky.), Speaker of the House Pro Tempore Patrick McHenry (R-N.C.), and House Minority Leader Hakeem Jeffries (D-N.Y.) “Incentives also help to improve care for patients by giving clinicians financial resources to expand services beyond those covered by traditional Medicare.”

The volume and diversity of the hundreds of supporters spans every corner of the country and shows the reach of APMs and the resulting incentive payments that will help ensure physicians and other clinicians have adequate resources to care for their patients, according to the National Association of ACOs (NAACOS) — which was among the health systems, hospitals, physician practices, health clinics, and accountable care organizations that co-signed the letter.

Other co-signers included the American Medical Association, the American College of Physicians, the Federation of American Hospitals, the American Academy of family Physicians, the National Rural Health Association, the Primary Care Collaborative, and the Medical Group Management Association.

Lawmakers in 2015 created a 5% incentive to help providers move into new payment models (such as ACOs) that encourage higher quality, more efficient, and more cost-effective care. The incentive has worked with nearly 300,000 clinicians receiving the incentive, NAACOS officials noted in a statement. Absent the 5% incentive, clinicians could be paid more under the Merit-based Incentive Payment System, which is an alternative to APMs. The letter argues an extension will give Congress more time to restructure physician payment overall to achieve its goals of better patient care at lower costs.

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“In 2022, ACOs produced $1.8 billion in savings that was returned to Medicare. This savings is significantly more than the $644 million paid in incentives this year,” according to the letter, which claims Medicare’s advanced APM incentives are “a good return on investment,” adding that [t]he Congressional Budget Office released data earlier this year showing that actual 2022 federal spending on Medicare and Medicaid was 9% lower than original projections. Some of the features that characterize participation in APMs, such as improved care management and more efficient use of technology, are among factors that may have contributed to these lower-than-expected costs.”

Many of the organizations that co-signed last week’s letter to Congress also sent an open letter to lawmakers in February outlining legislative priorities they claimed would improve adoption of value-based care models.