Nineteen supplier organizations requested Congressional leaders to decrease some High quality Fee Program necessities.
The letter, despatched on Thursday, claims many clinicians cannot meet key thresholds within the High quality Fee Program going into impact Jan. 1, 2021, and can drop out of this system consequently. The Medicare Entry and CHIP Reauthorization Act of 2015, which established the High quality Fee Program, requires in 2021 that clinicians obtain not less than 75% of Medicare half B funds by a complicated various fee mannequin or see not less than 50% of Medicare beneficiaries by the superior mannequin as a way to obtain a 5% bonus on half B Medicare claims. The necessities are completely different from 2020 when 50% of Medicare half B funds or 35% of Medicare beneficiaries need to be by the superior various fee mannequin to qualify for the bonus.
The supplier teams declare clinicians cannot realistically meet the brand new thresholds, citing a 2018 report from CMS discovering most superior APMs on common did not meet 2021 requirements.
The 5% bonus is a motivator for clinicians to take part in superior APMs and in the event that they know it is unlikely they will qualify, most will go away this system, the letter mentioned.
The supplier teams are asking Congress to freeze the 2020 thresholds for the subsequent two years. “This may guarantee clinicians presently collaborating in risk-bearing APMs will proceed to obtain bonus funds and encourage different clinicians to affix superior APMs,” the letter mentioned.
The supplier teams are hoping the subject might be addressed within the year-end spending invoice, in response to David Pittman, spokesman for the Nationwide Affiliation of ACOs.
About 183,306 clinicians participated in an alternate fee mannequin in 2018. Superior various fee fashions are risk-based alternatives for clinicians wherein they’re rewarded by bonuses for attaining sure price and high quality thresholds.
The flexibility for superior APMs to meaningfully decrease healthcare spending and enhance high quality has been scrutinized.
The letter was signed by a number of the greatest supplier organizations together with the American Medical Affiliation, the American Medical Group Affiliation, the American Hospital Affiliation, the Federation of American Hospitals and the Nationwide Affiliation of ACOs.
The letter was despatched to Senate Majority Chief Mitch McConnell, Senate Minority Chief Chuck Schumer, Speaker of the Home Nancy Pelosi and Minority Chief of the Home Kevin McCarthy. The places of work of McConnell and Schumer did not instantly reply to a request for remark.