Value-Based Care News

Providers Ask CMS Where Their 2019 Advanced APM Bonus Is

Nine industry groups called out the 2019 Advanced APM payment delay and urged CMS to pay clinicians pay clinicians as soon as possible for their 2017 performance.

Advanced APM bonus

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By Jacqueline LaPointe

- More than 90,000 clinicians are still waiting on the 2019 Advanced Alternative Payment Model (APM) bonus payment for their participation in 2017 and nine industry groups are demanding payment from CMS.

Advanced APMs are part of the Quality Payment Program, a value-based reimbursement system created under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The models require clinicians to take on downside financial risk in exchange for more favorable positive payment adjustments compared to the Quality Payment Program’s other track – the Merit-Based Incentive Payment System (MIPS).

In 2017, CMS promised to pay out a five percent bonus in the 2019 payment year to clinicians participating in one of the approved models. Clinicians, however, have yet to hear word about their bonus payments, nine industry groups claimed.

In a letter to CMS Administrator Seema Verma dated September 16, the groups, which included the American Medical Association, National Association of ACOs, and Health Care Transformation Task Force, expressed concerns about the Advanced APM bonus payment delay, especially considering the fact that clinicians participating in MIPS in 2017 have already started to receive their payment adjustments as of January 1, 2019.

“After nearly two years, the delay in payment of the bonus remains both unexpected and unexplained,” the letter stated.

The groups explained that the delay between performance and payment is unfair to clinicians who prepared for MACRA implementation by making investments, such as hiring staff to improve care coordination within and across clinical care teams and purchasing new technologies to support advanced care processes and performance data submission.

The groups also fear the two-year delay will impact Advanced APM participation and therefore, downside risk assumption.

The Trump Administration is actively pushing clinicians to assume downside financial risk through alternative payment models like the ones in the Advanced APM pathway. Through CMS, the administration even overhauled Medicare’s largest accountable care organization (ACO) last year to push providers to assume downside financial risk sooner.

Moving clinicians to risk-based models through the Advanced APM pathway is also a major goal of the Quality Payment Program. So far, participation in the pathway has nearly doubled from 2017 to 2018, CMS recently reported, and the agency anticipates between 165,000 to 220,000 clinicians to join an Advanced APM next year.

However, payment delays could deter providers from joining or continuing participation in an Advanced APM, the nine groups told the head of CMS.

“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,” the letter stated.

The groups urged CMS to “expeditiously pay” the 2019 Advanced APM bonus and commit to paying the bonusses no later than June 30th of each year going forward.