After delay, CMS says physicians can expect payments for advanced APM bonuses soon

hospital money
CMS says it will begin distributing bonus payments for doctors who participated in advanced APMs.(Getty/PraewBlackWhile)

After an appeal from nine physician organizations, the Centers for Medicare and Medicaid Services (CMS) says doctors and other healthcare professionals who qualify for an advanced alternative payment model (APM) performance bonus should get their money soon.

CMS announced in a fact sheet (PDF) that incentive payments will go out soon to clinicians who earned a performance bonus as part of their participation in advanced APMs in 2017. CMS said it would begin paying the incentive payments, due for the first year of its Quality Payment Program, starting this month.

The medical organizations, including the American Medical Association and the American Academy of Family Physicians, sent a letter (PDF) to CMS last month expressing concerns about a long delay in the payment of those performance bonuses.

APMs are one of two payment tracks under the 2015 Medicare Access and CHIP Reauthorization Act (MACRA). Qualifying participants were due a 5% bonus for performance year 2017, which was expected to be distributed in 2019.

“After nearly two years, the delay in payment of the bonus remains both unexpected and unexplained,” said the letter, which was also signed by the American College of Physicians, the American Medical Group Association, America's Physician Groups, the Health Care Transformation Task Force, Medical Group Management Association, National Association of Accountable Care Organizations and Premier Inc., a healthcare improvement company.

The groups said although it was nearing the end of the third quarter of 2019, none of the participants had received a bonus payment. In contrast, physicians and clinicians who participated in the Merit-based Incentive Payment System (MIPS), the other payment track under MACRA, began receiving payment adjustments for performance year 2017 on January 1, 2019.

Many physician practices and other healthcare organizations assumed considerable risks to transition to the APMs and were being unfairly penalized, the groups said. They said the delay could derail the momentum to move to value-based payments and discourage physicians from participating in advanced APMs in the future.

"Our members took the necessary steps and made significant investments to prepare for participation in advanced APMs," the groups stated, including hiring additional staff and investing in new technologies. "Our members took these steps and assumed financial risk to participate in advanced APMs with the expectation that some of these investments would be recouped in part by the 5% advanced APM bonus."

More than 99,000 clinicians participated in advanced APMs in 2017, a number that nearly doubled in 2018 to 183,306 participants, according to CMS.

The groups urged CMS to commit to paying the bonuses no later than June 30 in future years of the program.