Legislation seeks to preserve soon-to-expire APM bonus

Photo: John Baggaley/Getty Images

Two U.S. Senators, Sheldon Whitehouse, D-R.I., and Dr. John Barrasso, R-Wyo., have introduced bipartisan legislation that seeks to create a two-year extension for a 5% bonus for doctors who participate in alternative payment models. 

The bonus is slated to go away in 2023, and with limited time left in the current legislative session, the bill seeks to stave that off.

The bill would extend the 5% advanced alternative payment model incentive payment for providers for an additional two years and ensure that qualification thresholds remain at attainable levels for practices that participate in Medicare's advanced APMs. This incentive-based payment is set to expire at the end of the year.

"As a doctor, I know how critical it is for Medicare to meet the healthcare needs of American seniors," Barrasso said in a statement. There is agreement on both sides of the aisle that alternative payment models are a key solution to help more seniors receive better care at a lower cost."

"Rhode Island's accountable care organizations have been national leaders at improving patient care and lowering costs," Whitehouse said in a statement. "Medicare has earned back millions from their success. We need to encourage more healthcare innovation – not pull the rug out from under the people who are making the system work better for everyone."

WHAT'S THE IMPACT?

The legislation garnered a largely positive initial reaction from several groups, including the American Medical Group Association, which endorsed the bill Wednesday.

"The Advanced APM program is critical in Medicare's continued transition to value," said AMGA President and CEO Dr. Jerry Penso. "This bill ensures that Medicare offers the support providers need to start and continue the journey to value. Passage of this bill sends a clear signal that value is here to stay in the Medicare program."

Premier also lent its endorsement, saying it applauded Whitehouse and Barrasso for their efforts.

"Providing the certainty of a two-year runway is crucial to enable providers engaged in these innovative models to focus on longer-term strategic planning and care transformation," Premier said in a statement. "Enacting these changes this year would significantly advance the movement from volume-based payments to alternative payment models and risk-based arrangements. Premier urges Congress to extend the AAPM bonuses and address the qualifying thresholds this year."

It's unclear at this point whether lawmakers will have enough time to consider the bill before the end of the year.

THE LARGER TREND

Under the Medicare Access and CHIP Reauthorization Act of 2015, clinicians can receive a 5% bonus on Part B payments if they meet certain thresholds of payment or patients through an advanced APM.

In 2020 a group of 19 healthcare organizations co-signed a letter calling on congressional leaders to freeze the current thresholds for incentive payments to APM practices to ensure providers participating in risk-bearing APMs get their bonuses and to encourage new participation.

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com