Now is the Time to Extend the Advanced APM Incentive Payment

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is designed to encourage providers to move into value-based care arrangements that prioritize high-quality, patient-centered care. Under MACRA’s creation of the Quality Payment Program (QPP), two tracks are offered to providers: the Merit Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (AAPMs) track. MACRA encourages providers to participate in the AAPM track and have greater accountability for care and higher levels of risk and reward by providing a 5% Advanced APM incentive payment for all qualified providers in addition to the normal Medicare physician fee schedule payment.  However, 2022 represents the final performance year (PY) for providers to be eligible for this payment incentive. After PY 2022, the financial incentive to participate in the Advanced APM track will no longer exist. Congress must act now to extend the availability of the incentive payment and keep up momentum on value-transformation.

Over the AAPM Track’s first four years, the incentive payment has served as a critical driver for participation in AAPMs. Several points support extending the 5% incentive payment, including:

  • The number of SSP ACO beneficiaries increased each year from 2017 to 2020 with growth driven by participation in the AAPM tracks.
  • SSP ACOs produced net per beneficiary savings annually from 2017 to 2020 with AAPM track ACOs generating almost 36% higher net per beneficiary savings compared to non-AAPM track ACOs between 2018-2020.
  • Total AAPM track ACO net savings to CMS increased 30-fold from 2017 to 2020.

These results show the positive impact the incentive payments are having on providers moving forward on value transformation. Now more than ever, it is imperative that this incentive payment be extended to PY 2023 and beyond to support the continued transformation of our health care system to one that rewards value of care over volume of services delivered.

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