Some 501 accountable care organizations and other provider entities are urging Congressional leadership of both parties to modify the “unrealistic threshold tests” set out in the 2021 edition of the bipartisan Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.
In its initial iteration, MACRA offered a 5% bonus for providers who switched from fee-for-service Medicare to advanced alternative payment models (APMs). To show their commitment to the program, providers opting in had to meet threshold goals on either revenues or patient volumes handled through APMs, the signatories remind Senate Majority Leader Mitch McConnell, House Speaker Nancy Pelosi, Senate Minority Leader Charles Schumer and House Minority Leader Kevin McCarthy.
For 2020 the threshold for APM revenue is 50% and for APM patient volume 35%.
Next year, the revenue threshold will spike to 75% and the patient participation threshold to 50%.
The jolt of such sharp raisings of the bar, the signatories argue in a Dec. 2 letter, will cost many deeply invested providers their incentive payments.
“If providers cannot count on receiving these bonus payments due to unrealistic thresholds, fewer providers will be willing to participate in APMs in the future, exactly the opposite of what MACRA’s authors intended when they drafted the threshold tests,” the letter reads. “This would represent an unfortunate setback in the progress we have made in advancing the value movement and would undermine Medicare’s long-term transition to greater levels of performance-based risk.”
With that the authors beseech the leaders to freeze MACRA thresholds at 2020 levels for the next two performance years, 2021 and 2022.
“This freeze will give us the flexibility and financial security we need to continue to innovate and improve population health for our patients, as well as to continue to drive forward models that create a fiscally healthy future for the Medicare program,” they write.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.