Nineteen provider organizations asked Congressional leaders to lower some Quality Payment Program requirements.
The letter, sent on Thursday, claims many clinicians can't meet key thresholds in the Quality Payment Program going into effect Jan. 1, 2021, and will drop out of the program as a result. The Medicare Access and CHIP Reauthorization Act of 2015, which established the Quality Payment Program, requires in 2021 that clinicians receive at least 75% of Medicare part B payments through an advanced alternative payment model or see at least 50% of Medicare beneficiaries through the advanced model in order to receive a 5% bonus on part B Medicare claims. The requirements are different from 2020 when 50% of Medicare part B payments or 35% of Medicare beneficiaries have to be through the advanced alternative payment model to qualify for the bonus.
The provider groups claim clinicians can't realistically meet the new thresholds, citing a 2018 report from CMS finding most advanced APMs on average didn't meet 2021 standards.
The 5% bonus is a motivator for clinicians to participate in advanced APMs and if they know it's unlikely they'll qualify, most will leave the program, the letter said.
The provider groups are asking Congress to freeze the 2020 thresholds for the next two years. "This would ensure clinicians currently participating in risk-bearing APMs will continue to receive bonus payments and encourage other clinicians to join advanced APMs," the letter said.
The provider groups are hoping the topic will be addressed in the year-end spending bill, according to David Pittman, spokesman for the National Association of ACOs.
About 183,306 clinicians participated in an alternative payment model in 2018. Advanced alternative payment models are risk-based opportunities for clinicians in which they are rewarded through bonuses for achieving certain cost and quality thresholds.
The ability for advanced APMs to meaningfully lower healthcare spending and improve quality has been scrutinized.
The letter was signed by some of the biggest provider organizations including the American Medical Association, the American Medical Group Association, the American Hospital Association, the Federation of American Hospitals and the National Association of ACOs.
The letter was sent to Senate Majority Leader Mitch McConnell, Senate Minority Leader Chuck Schumer, Speaker of the House Nancy Pelosi and Minority Leader of the House Kevin McCarthy. The offices of McConnell and Schumer didn't immediately respond to a request for comment.