Providers make full-court press to convince lawmakers to save value-based care bonus

Several provider groups and organizations are leading a concerted effort to get Congress to tuck in an extension of a 5% bonus to physicians that participate in value-based care before the money goes away after 2022. 

The effort by several provider groups underscores major concerns over how the loss of the bonus could stymie momentum in the shift to alternative payment models

“I think of it really as a way of helping to promote healthcare practices and practice recruitment,” said Kisha Davis, vice president of health equity for ACO services organization Aledade, during a briefing on Capitol Hill Thursday.

Davis said the 5% bonus can help physicians with an added incentive to enter payment models because they have the extra money to cover startup costs. This is especially crucial to entice providers that treat underserved communities and may not have the costs to participate in a model.

The Medicare Access and CHIP Reauthorization Act of 2015 included the 5% bonus aimed at physicians that participate in an advanced alternative payment model. This year, more than 300,000 clinicians are expected to take advantage of the bonus, according to the National Association of ACOs.

This money has helped pay for various tools such as workflow improvements, data analytics and new patient engagement strategies, according to a letter led by more than 800 physician and healthcare groups and systems.

Groups charge the extra money has helped not only cover startup costs but also new programs such as wellness initiatives and hiring care coordinators. 

“These are services that are not typically reimbursed through Medicare but improve patient health outcomes and wellbeing,” the letter said. 

A key part of the effort is to help explain to lawmakers the need for value-based care, emphasizing the savings generated by ACOs and the return on investment. 

“The growth of APMs has produced a ‘spill-over’ effect on care delivery across the nation, slowing the overall rate of growth of healthcare spending,” according to the letter that includes the American Medical Association, the National Association of ACOs and America’s Physician Groups among the signers.

Advocates are hoping for Congress to include the 5% extension in a must-pass spending package expected to be considered in December. Congress is moving this week to pass a short-term spending bill that funds the federal government through Dec. 15.

They also hope to include the entirety of the Value in Health Care Act, a bipartisan bill that in addition to extending the 5% bonus gives the Centers for Medicare & Medicaid Services new powers to adjust the thresholds for how physicians can qualify for the payments.

Several groups are also pushing for Congress to stave off a 4% cut to Medicare payments under the PAYGO rule and reverse a planned 4.5% cut expected to go into effect in 2023 as part of the Physician Fee Schedule.