Value-Based Care News

CMS Says Clinicians to Receive Advanced APM Bonus Payments Soon

After a delay, a new fact sheet from CMS says the agency started providing Advanced APM bonus payments to qualifying clinicians in September.

Advanced APM bonus payments

Source: Thinkstock

By Jacqueline LaPointe

- In a fact sheet created on Sept. 27, CMS announced that Advanced Alternative Payment Model (APM) bonus payments for participation in an approved model in 2017 will be going out to qualifying clinicians soon if they have not already received them.

The federal agency stated in the fact sheet that it will be paying out Advanced APM bonuses starting in September 2019. Clinicians will also have the opportunity later this fall to verify their bonus payment amount, which should be five percent of estimated payments for Medicare Part B covered professional services furnished during the calendar year preceding the payment year.

The news came days after nine healthcare industry groups, including the American Medical Association, American College of Physicians, and American Medical Group Association, sent a letter to CMS Administrator Seema Verma urging the agency to pay Advanced APM bonuses as quickly as possible.

“After nearly two years, the delay in payment of the bonus remains both unexpected and unexplained,” the groups wrote before expressing concerns about the investments made by clinicians with the expectation of receiving a five percent bonus payment.

“Our members took the necessary steps and made significant investments to prepare for participation in Advanced APMs, including hiring additional staff to improve care coordination within and across clinical care teams and investing in new technologies to support advanced care processes and performance data submission,” the letter stated. “Our members took these steps and assumed financial risk to participate in Advanced APMs with the expectation that some of these investments would be recouped in part by the five percent Advanced APM bonus.”

As of Sept. 16, none of the groups’ members who participated in an Advanced APM in 2017 received their bonus payments, the letter stated.

In contrast, clinicians who participated in the Quality Payment Program’s other track – the Merit-Based Incentive Payment System (MIPS) – had started to receive their payment adjustments as of Jan. 1, 2019 for their 2017 performance.

Over 99,000 clinicians participated in an Advanced APM in 2017, according to a report from CMS. The number of clinicians choosing to participate in the Quality Payment Program through the track also nearly doubled in 2018.

But delays in payment could damper future Advanced APM participation despite that being one of the Quality Payment Program’s ultimate goals, the industry groups stated.

“If these payments are not made soon, we fear clinicians could be dissuaded from participating in Advanced APMs in the future, or worse, be forced to make difficult budgetary choices in the short-term that could hinder patient care or inhibit their ability to succeed in APMs, such as letting go of additional staff hired to support enhanced care coordination and other essential functions,” they argued in the letter.

In the fact sheet, CMS explained that paying out Advanced APM bonuses hinges on claims data.

The agency calculates bonus payments using claims submitted with dates of services from Jan. 1 through Dec. 31 of the base period and processing dates of Jan. 1 of the base period through March 31 of the subsequent payment year to allow for claims run-out.

For the 2019 Advanced APM bonus payments, that means CMS had to analyze claims submitted with dates of services from Jan. 1, 2018, through Dec. 31, 2018, and processing dates of Jan. 1, 2018, through March 31, 2019.

“This methodology is consistent with the claims run-out timeframes used for reconciliation payments in several current APMs, such as the Shared Savings Program, the Next Generation Accountable Care Organizations (ACO) Models, and the Comprehensive ESRD Care Model,” the agency stated.

With claims analyses complete, CMS anticipates paying clinicians who sufficiently participated in an Advanced APM.

However, industry groups still called for payment reform. In their letter to the head of CMS, the groups asked CMS to pay Advanced APM bonuses no later than June 30th of each year going forward.