Sustain Medicare’s Transition to Value-Based Care

Eligibility to earn Medicare’s Advanced Alternative Payment Model (AAPM) incentive payments expired on December 31, 2024.

  • Failing to extend these incentives makes it harder for clinicians to continue providing innovative, value-based care that lowers long-term health care costs for millions of seniors on Medicare.
  • Qualifying thresholds increased dramatically, making it more difficult for clinicians to earn exemptions from the Merit-based Incentive Payment System (MIPS) and adding reporting burdens and costs to practices already under financial strain.

HEALTH LEADERS CALL ON CONGRESS TO SUPPORT AAPMS

24 health care associations and more than 550 physician practices, health systems, and ACOs sent a letter calling on lawmakers to support value-based care clinicians by:

  • Passing the Preserving Patient Access to Accountable Care Act (H.R. 786/S. 1460), a bipartisan bill that extends the incentives and maintains reasonable qualifying thresholds, will allow accountable care to continue to keep seniors healthy.

Impact on Seniors & Clinicians

  • AAPM incentives directly benefit seniors in traditional Medicare through more coordinated and cost-effective care.
  • Incentives help practices grow care teams that coordinate services, invest in population health tools, and offer care not typically paid for by traditional Medicare.
  • If Congress fails to act, more than 500,000 physicians and other health care providers will have less capacity to provide enhanced coordination and services.
  • 13 million seniors on Medicare could see reductions in these supplemental services that help keep them healthy.
  • In the last decade, accountable care organizations helped lower Medicare spending by $34 billion. Spending growth in Medicare and Medicaid was also 9 percent lower than Congressional Budget Office projections due to better health management and technology.
  • The large increase in APM qualifying thresholds will result in increased burdens and costs on nearly 100,000 clinicians that may be forced back into MIPS.