November 14, 2022 – On November 2, 2022, over 40 bipartisan House lawmakers sent a letter to House Speaker Nancy Pelosi and Minority Leader Kevin McCarthy requesting an extension of the 5% bonus for Alternative Payment Model (APM) participation. 

The 5% bonus payment was included in the Medicare Access and CHIP Reauthorization Act (MACRA). It was an incentive to encourage healthcare providers to transition into alternative payment models and the bonus was designed to allow providers to reduce cost-sharing and invest in social determinants of health (SDOH) initiatives. 

Unfortunately, the 5% bonus payment is set to expire at the end of 2022 if Congress does not act to extend it. In the letter, the lawmakers stated that if the bonus is allowed to expire, it would negatively impact almost 300,000 clinicians and slow the growth in alternative payment model participation. 

“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 House members wrote.

They also specifically noted that the alternative payment models not only reduce costs but also increase the quality of care for seniors across the country. Thus, they requested that Congress include Section 4 of the Value in Health Care Act (H.R. 4587) in an end-of-year legislative package. This would extend the 5% APM incentive payments in the coming years and continue encouraging the transition away from fragmented, fee-for-service payment systems into APMs where providers are accountable for the cost and quality of care. 

The alternative payment model bonus incentive extension does not just have the support of lawmakers. Over 800 accountable care organizations (ACOs), and practices sent a letter to Congress in September asking them to save the bonus incentive. 

“We’ve learned this 5 percent 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 percent in 2017 when the incentives first became available,” Clif Gaus, ScD, president, and chief executive officer of the National Association of ACOs (NAACOS), stated in a recent press release.

He later added, “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 letter was signed by 44 lawmakers in total, 28 Democrats and 16 Republicans. The list of signees includes: 

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); Jeff Van Drew (R-NJ).

To read the letter House Lawmakers Requesting Extension of Value-Based Payment Incentives, click here.