19 provider groups urge Congress to lower Quality Payment Program requirements


Nineteen provider groups are urging Congress to lower the threshold requirements for the Quality Payment Program, established under the Medicare Access and CHIP Reauthorization Act of 2015.

In the Nov. 19 letter, the organizations argue that clinicians will not be able to meet the increasing threshold requirements for the program that take effect Jan. 1. As a result, they may drop out of the program that encourages clinicians to leave traditional fee-for-service reimbursement and adopt risk-based models. 

Currently, to qualify for a 5 percent incentive payment under the Quality Payment Program, clinicians must have 50 percent of Medicare Part B payments or 35 percent of Medicare beneficiaries in the advanced alternative payment model. Next year, the threshold is set to rise to 75 percent of Medicare Part B payments or 50 percent of Medicare beneficiaries in the advanced alternative payment model.

The provider groups argue that they now understand the "original thresholds set in MACRA are too high."

They supported their argument by pointing to a recent CMS report that reveals that most clinicians would not qualify for the bonus in 2021. On average, the percent of payments in 2018 through the program was 48 percent. 

The provider groups also say that the pandemic has made it more challenging to meet the thresholds. They are asking Congress to freeze the threshold at the current rate for 2021 and 2022.

"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 provider groups wrote.

The letter was signed by many large provider groups, including the American Hospital Association, American Medical Association, Federation of American Hospitals, Association of American Medical Colleges and National Association of ACOs.

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