About 90,000 clinicians who participated in advanced alternative payment models in 2017 are concerned that they haven't received bonuses from the CMS.
Advanced alternative payment models, also known as advanced APMs, were created under MACRA in 2015 and offer an opportunity for clinicians to receive a 5% bonus to their Medicare payments if they participate. It requires clinicians to take on significant downside risk. The CMS said it would provide the positive payment adjustment in 2019 to eligible clinicians who participated in 2017. But providers are worried the bonuses still haven't been distributed.
In a letter Tuesday to CMS Administrator Seema Verma, nine provider groups, which include the American Medical Association and the National Association of ACOs, claim the bonus payments are delayed and it's unclear why.
"If these payments are not made soon, we fear clinicians could be dissuaded from participating in advanced APMs in the future," the letter said.
In an email, a CMS spokeswoman said the CMS is currently finalizing the total amount in bonus payments it will distribute to the clinicians. The spokeswoman added these will be "lump-sum payments calculated as 5% of total 2018 (Medicare) Part B billings."
Unlike the Merit-based Incentive Payment System (MIPS), bonuses for advanced APMs aren't budget neutral so the CMS must get bonus dollars from its own budget.
The Trump administration has been pushing providers to take on downside risk through payment models. It recently revamped the Medicare Shared Savings Program and it enables accountable care organizations to qualify as advanced APMs even at the basic levels of the program.
The provider groups said in the letter they "fear" clinicians will have to make budget cuts if they don't receive the bonuses soon. Organizations typically have to make significant investments in information technology, support staff and other services to successfully participate in advanced APMs but do so with the hope that they'll receive bonuses.
Adding to the concern that their bonuses are delayed is the fact that 2017 participants in MIS already began receiving payment adjustments.
"The reason for the holdup is unclear," the letter said.
