Participation in Alternative Payment Models Set to Slow If Incentives Expire
The National Association of Accountable Care Organizations (NAACOS) praised the more than 40 House lawmakers who support extending a 5% incentive payment in Medicare for physicians and other clinicians who practice in value-based payment models. The members of Congress made their request in a bipartisan letter sent November 2, 2022, to House Speaker Nancy Pelosi and Minority Leader Kevin McCarthy.
Unless Congress extends the incentive by December 31, millions of patients will lose access to value-based care. Today, roughly 300,000 clinicians receive this 5% incentive on their Medicare payments, with risk-bearing accountable care organizations being the dominant mechanism to secure the payment. Expiration of these incentives will discourage future participation in models that have seen growing uptake in recent years. More than 800 accountable care organizations (ACOs), health systems, and physician group practices asked Congress to save the incentive in a letter sent in late September.
“We’ve learned this 5% 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% in 2017 when the incentives first became available,” says NAACOS President and CEO Clif Gaus, ScD. “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.”
The incentive allows ACOs to reinvest in care transformation initiatives that benefit patients—like care coordination efforts, services that address social determinants of health, and technology that improves patient engagement. As a result, ACOs generated $3.6 billion in gross savings in 2021, far exceeding the $613 million CMS paid in 2022 incentive payments. Value-based care has slowed the rate of growth of health care spending, saving more than $600 billion.
The letter was signed by 44 lawmakers, 28 Democrats and 16 Republicans, including Peter Welch (D-VT), Darrin LaHood (R-IL), Suzan DelBene (D-WA), Brad Wenstrup (R-OH), Earl Blumenauer (D-OR), Michael Burgess (R-TX), Cynthia Axne (D-IA), Nanette Barragán (D-CA), Ami Bera (D-CA), Sanford Bishop (D-GA), Lisa Blunt Rochester (D-DE), Brendan Boyle (D-PA), Larry Bucshon (R-IN), Lou Correa (D-CA), Neal Dunn (R-FL), Jake Ellzey (R-TX), Drew Ferguson (R-GA), Brian Fitzpatrick (R-PA), Jared Golden (D-ME), Josh Gottheimer (D-NJ), Dusty Johnson (R-SD), Daniel Kildee (D-MI), Derek Kilmer (D-WA), Raja Krishnamoorthi (D-IL), Ann Kuster (D-NH), James McGovern (D-MA), Daniel Meuser (R-PA), Carol Miller (R-WV), Mariannette Miller-Meeks (R-IA), Joseph Morelle (D-NY), Markwayne Mullin (R-OK), Greg Murphy (R-NC), Tom O’Halleran (D-AZ), Jimmy Panetta (D-CA), Stacey Plaskett (D-VI), Brad Schneider (D-IL), Kim Schrier (D-WA), Terri Sewell (D-AL), Mikie Sherrill (D-NJ), Adrian Smith (R-NE), Darren Soto (D-FL), Thomas Suozzi (D-NY), Mike Thompson (D-CA), and Jeff Van Drew (R-NJ).
“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 letter states.
NAACOS and five others recently launched the Alliance for Value-Based Patient Care, a coalition of major US health care organizations to support federal policies that promote and reward value in health care delivery.
Source: National Association of Accountable Care Organizations