NAACOs urges Congress to address qualifying thresholds in value-based care models

Calculator that says "Medicare" on it on top of money, next to bottle of pills
A new ACO survey warns that they may struggle to meet qualifying therholds. (Getty Images/liveslow)

Many providers are concerned about rising thresholds in Medicare ACOs, which could lead them to reconsider participation in value-based models, according to a new survey.

The National Association of Accountable Care Organizations (NAACOs) surveyed 116 ACOs across a number of programs, and found that 90% were concerned they would be unable to reach qualifying thresholds in 2021, which must be met to receive bonuses under the program.

The survey shows that 96% of the responding ACOs would not meet the 2021 targets based on their 2020 performance.

The bonus payments are a critical incentives that allow participants to continue investing in the ACO, NAACOs said.

RELATED: New bill seeks to boost participation in advanced payment models, ACOs via several reforms

“These bonuses are critical to Medicare’s value movement,” said Clif Gaus, NAACOS president and CEO, in a statement. “The current thresholds are a challenge for many ACOs."

The survey respondents highlighted the ways they use the bonuses, such as investments in care coordination and data analytics (noted by 58%) and supporting ways to move to models with greater risk (54%).

NAACOs says the results should spur legislators to take steps to address the thresholds, especially as lowering Medicare spending is of bipartisan interest. ACOs, the group said, have been the key driver of savings for the program among value-based care models.

"To increase them again in 2021 would put the incentive out of reach for nearly everybody," Gaus said. "Congress intended to shift Medicare payment to a value-based approach, and we are seeing the benefits of that transformation through improved patient care and reduced costs. We need Congress to correct these thresholds to prevent the value movement from stalling.”