Senate Introduces Bill to Extend 5% Incentives for APMs

A version of this article originally appeared on Medical Economics®. It has been edited.

A bipartisan Senate bill has been introduced that would provide a two-year extension to the 5% incentives for alternative payment models that will expire at the end of the year without congressional action.

The bill, called the Value Act, would not only extend the incentives, but also make changes to CMS’s value-based care programs, including:

• Gives CMS the authority to adjust the thresholds to secure those incentive payments, allowing more opportunities to bring rural, underserved, primary care or specialty practices into APMs;
• Eliminates the artificial revenue-based distinction that disadvantages rural and safety net providers that are critical to improving access to care and improving health equity;
• Creates a more fair, more transparent process to set financial spending targets so that ACOs are not penalized for their own success;
• Establishes a voluntary track for ACOs to take on higher levels of risk;
• Provides technical assistance for clinicians new to APMs; and
• Studies ways to increase parity between APMs in traditional Medicare and Medicare Advantage so that both programs are attractive and sustainable options.

“ACOs [accountable care organizations] have provided a tremendous return on Congress’s investment, generating billions in savings already,” said National Association of ACOs (NAACOS) President and CEO Clif Gaus, in a statement. “Lawmakers would be wise to further incentivize value-based care, which has been shown to provide better patient care at lower costs. Lawmakers can start by extending Medicare’s incentives for participating in value-based care models. Continuing these incentives means that clinicians are able to reinvest in improving care and enhancing beneficiary services.”

A companion House bill (H.R. 5013) was introduced in July and had the support of 17 of the nation’s leading health stakeholder groups, including Accountable for Health, American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, American College of Physicians, American Hospital Association, American Medical Association, America’s Essential Hospitals, AMGA, America's Physician Groups, Association of American Medical Colleges, Federation of American Hospitals, Healthcare Leadership Council, Health Care Transformation Task Force, Medical Group Management Association, National Association of ACOs, National Rural Health Association, and Premier, Inc. A summary of the bill is available online, along with a section-by-section summary of the bill.

According to NAACOS, ACOs have saved Medicare more than $22 billion in gross savings and nearly $9 billion in net savings since 2012. Importantly, data show these ACOs continued to provide high-quality care and yield satisfied patients. Today, ACOs care for nearly 20% of all Medicare patients and nearly a third of traditional Medicare patients. Medicare, ACOs allow patients to maintain their choice of provider, and there are no network restrictions or use of prior authorization.

CMS released data in September showing that ACOs in the Medicare Shared Savings Program (MSSP) generated $1.8 million in savings in 2022, and the agency has a goal of having 100% of people with traditional, fee-for-service Medicare as part of an accountable care relationship by 2030.

Compared with similarly sized clinician groups not participating in the MSSP, ACOs had statistically significant higher performance for quality measures related to diabetes and blood pressure control, breast and colorectal cancer screening, tobacco screening and smoking cessation, and depression screening and follow-up.

“The Medicare Shared Savings Program helps millions of people with Medicare experience coordinated health care while also reducing costs for the Medicare program,” CMS Administrator Chiquita Brooks-LaSure, said in a statement at the time. “CMS will continue to improve the program, and it is exciting to see that accountable care organizations are continuing to be successful in delivering coordinated, high-quality, affordable, equitable, person-centered care.”