ACOs fret over losing dependable MACRA bonus after this year

Accountable care organizations are worried about how the loss of a 5% quality bonus could affect the recruitment and retention of physicians as the window for Congress to act to extend it narrows. 

A 5% bonus payment to physicians that meet quality thresholds if they are in an alternative payment model will expire after this year. ACOs say the bonus, where 2022 is the final performance year, is a major selling point to entice physicians to enter into models as the money goes directly to them. 

“It is a knowable, plannable and countable dollar,” said Emily Brower, senior vice president of clinical integration and physician services for the hospital system Trinity Health. 

Brower and several other ACO officials remarked about the need for the bonus payment, created under the Medicare Access and CHIP Reauthorization Act, while at the fall meeting of the National Association of ACOs (NAACOS). 

She said the quality bonus payment is made regardless of the ACO’s performance on the benchmark, which is the quality and savings target an organization must meet to qualify for savings.

“We see … those dollars as being able to work in tandem with the funding that comes from the ACO,” Brower said. 

The funding is critical to keep in place infrastructure that has been used to improve quality, said Melanie Matthews, CEO of MultiCare Connected Care and Physicians of Southwest Washington.

“ACOs during the pandemic our quality didn’t suffer and it was because we had mechanisms in place: care teams and outreach methods, telemedicine … that we were able to engage our patients despite not coming into the office,” she said. 

There are several must-pass legislative vehicles that lawmakers can use to extend the bonus payments, chief among them a continuing resolution to fund the government before current funding expires at the end of this month. 

Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure reiterated her support for the bonus payment at the conference but stressed it is in Congress’ hands. 

She said that ACO advocates need to help lawmakers understand why the payments are so vital, including underlining the benefits of value-based care as a whole. 

“There are so many competing priorities in healthcare and across the government,” she said. “The ones that resonate are the ones that are going to really move the needle.”

She added that the agency is doing more research to determine what words resonate as value-based care only relates to a certain part of the healthcare system. 

“It is important for you all as you are showing your leadership and members of Congress to really talk about it for what it means for the people we are serving,” she told the crowd at the NAACOS conference.