New alliance seeks to save value-based care bonus set to expire in 2023

A new alliance hopes to persuade lawmakers to keep around a 5% bonus to doctors that sign up for payment models and raise awareness on the benefits of value-based care. 

Six major advocacy organizations announced Tuesday that they would form the Alliance for Value-Based Patient Care. Their immediate goal is to convince Congress to preserve the 5% bonus before it expires after this year. 

“There’s a lot of consequences to not extending that 5% bonus, and we’re just trying to make legislators more aware of that and hope that we can succeed,” said Clif Gaus, president of the National Association of Accountable Care Organizations—one of the groups in the alliance—in an interview with Fierce Healthcare. 

The ther groups in the alliance are the American Medical Association, Premier Inc., the Health Care Transformation Task Force, America's Physician Groups and the American Medical Group Association.

The bonus applies to any physician that participates in an Advanced Alternative Payment Model. Advocates say the bonus can help entice physicians to enter a model and cover startup costs.

The alliance said that approximately 300,000 physicians rely on the incentive, and one-third could drop out of models if it goes away, citing projections from the Centers for Medicare & Medicaid Services (CMS).

Gaus said physicians are already facing a potential 4.5% cut to Medicare payments finalized in the latest Physician Fee Schedule rule released earlier this week. Doctor advocacy groups are making a separate effort to get Congress to forestall that cut in the coming weeks. 

ACO participation has been relatively flat in the past several years, but there have been more entrants thanks to newer models such as ACO REACH, which offer partially capitated payments to physicians' offices, Gaus added. 

The alliance is concerned the loss of the bonus could lead to a backslide in participation. 

“The transition to value-based care takes time, and our health system cannot afford to take steps backward,” according to the group’s website, 

The push to save the quality bonus is the latest request from the healthcare industry for consideration during the lame duck congressional session set to start after the midterm elections. Other groups are pressing for ending the 4.5% Medicare cut to physicians and delaying a 4% cut under the PAYGO law, which mandates cuts if federal spending reaches a certain level. 

Advocates are eyeing a Dec. 15 spending package to include many requests.

The second phase of the alliance includes a marketing campaign next year to help raise awareness about the benefits of value-based care, Gaus said. 

CMS Administrator Chiquita Brooks-LaSure has previously noted that more needs to be done to share the benefits of value-based care. 

The agency also finalized several changes in a recent payment rule to improve ACO participation, including offering upfront investments to providers in underserved areas to get them to sign up. CMS also introduced several changes to the calculation of the benchmark for ACOs, which determines the spending levels they must meet to qualify for savings.