Keep bonus criteria for alternative payment models, 500+ ACOs, providers tell Congress

Criteria that determine which providers in alternative payment models get bonuses should stay the same, more than 500 ACOs, providers and health system leaders urged in a Dec. 2 letter to Congress. 

The letter concerns requirements outlined in the 2015 Medicare Access and CHIP Reauthorization Act. The act includes a 5 percent bonus for providers who were willing to switch from a traditional fee-for-service Medicare model to an advanced alternative payment model that takes on more financial risk.

For providers to qualify for the bonus, they have to meet participation thresholds. In 2020, those thresholds were 50 percent of revenue and 35 percent of patients. But next year, those thresholds are slated to climb to 75 percent of revenue and 50 percent of patients.

In a survey from earlier this year, the National Association of ACOs found that 96 percent of the 216 ACO respondents wouldn't meet the 2021 thresholds based on their 2020 performance. 

"As a result, many practices who have assumed considerable financial risk and who have invested significant resources into advancing the value-based care movement will not receive their incentive payments," the letter to Congress reads.

The letter asked Congress to freeze the bonus thresholds at the 2020 levels for the next two performance years.

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