AAFP, Others Demand Answers on Advanced APM Bonus Delays

CMS Responds by Announcing Payments Will Soon Be Distributed

October 02, 2019 02:08 pm Michael Devitt

Who says hard work doesn't pay off?

[young man saying pay up]

Less than two weeks after the Academy and eight other medical and health care organizations sent a letter(2 page PDF) to CMS Administrator Seema Verma, M.P.H., that expressed strong concerns about a lengthy delay in bonus payments tied to clinicians' 2017 participation in advanced alternative payment models, the agency announced on Sept. 27(qpp-cm-prod-content.s3.amazonaws.com) that qualifying participants would soon begin receiving their incentive payments.

The organizations' stance -- and the agency's quick response -- highlight the AAFP's continuing advocacy to ensure that the long-term "value over volume" objectives of the Medicare Access and CHIP Reauthorization Act of 2015 remain solidly on track.

Under MACRA, family physicians and other health care professionals with significant participation in advanced APMs for performance year 2017 were to receive a 5% bonus to be paid out during calendar year 2019. But with the end of the year in sight, concerns have mounted that the bonus payments were being delayed or, indeed, would not be distributed at all. That prospect, in turn, has threatened to derail the law's momentum and discourage physicians from participating in advanced APMs in the future.

Story Highlights
  • On Sept. 16, the AAFP and eight other organizations sent a letter to CMS expressing concerns about a delay in payment of a performance bonus to clinicians who participated in advanced alternative payment models in 2017.
  • The letter stated that many clinicians had assumed considerable financial risks to transition to the alternative payment models and were being unfairly penalized for their investments.
  • In response, CMS announced on Sept. 27 that qualifying participants would soon begin receiving their incentive payments.

"After nearly two years, the delay in payment of the bonus remains both unexpected and unexplained," said the letter, which was co-signed by the American College of Physicians, AMA, American Medical Group Association, America's Physician Groups, Health Care Transformation Task Force, Medical Group Management Association, National Association of Accountable Care Organizations, and Premier Inc., a health care improvement company.

"Our members took the necessary steps and made significant investments to prepare for participation in advanced APMs," the groups 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 5% advanced APM bonus."

According to a July 2019 blog post(www.cms.gov) attributed to Verma, more than 99,000 clinicians participated in advanced APMs in 2017.

As of Sept. 16, however, none of the groups' members who participated in an advanced APM in 2017 had received a bonus payment, said the letter.

In contrast, clinicians who participated in the Merit-based Incentive Payment System -- QPP's other value-based payment track -- began receiving payment adjustments for performance year 2017 on Jan. 1, 2019.

"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," the groups stated.

In addition to urging CMS to "expeditiously pay" the earned bonus amounts, they also suggested that the agency commit to paying future bonuses no later than June 30 of each year.

The letter concluded with a reminder to Verma of the need for CMS to work with clinicians and others to ensure participation in innovative payment models such as advanced APMs.

"It is important that CMS continues to work with stakeholders to encourage participation in value-based payment models," the letter said. "We look forward to a response regarding the timely payment of the 5 percent bonus to our eligible members to strengthen and improve the MACRA program for current and future participants."

Additional details on the incentive payments have been published on FPM journal's Getting Paid blog. According to a Sept. 30 blog post, qualifying participants can verify their information through the QPP portal.(qpp.cms.gov) Those with additional questions may contact the QPP Service Center by calling 866-288-8292 or via email.

Related AAFP News Coverage
Leader Voices Blog: Our Wins Are Big Steps Toward Better Health Care Landscape

Participating in CMS' 2019 QPP? New Resources Available

More From AAFP
Practice Management: Advanced Alternative Payment Model (AAPM) -- Frequently Asked Questions