In a letter to CMS, 273 physician groups and independent practice associations called on the agency to develop advanced alternative payment model incentives for physicians assuming risk in Medicare Advantage contracts with health plans, and that the APMs be based on models outlined under the Medicare Access and CHIP Reauthorization Act.
Under MACRA, APMs that require providers to bear two-sided risk qualify as "advanced." The two-sided risk allows participants to receive bonuses if quality and utilization metrics are met or face penalties if costs are higher than a specific benchmark. Clinicians participating in advanced APMs can earn a lump sum bonus of up to 5 percent on Medicare payments each year from 2019 through 2024.
The physician groups said those advanced APMs are only available for traditional Medicare and not for physicians in Medicare Advantage arrangements. The groups urged CMS to "address this inequitable approach" and consider Medicare Advantage risk contracts toward MACRA's threshold requirements for the two-sided risk models.
"Recognition and incentives for the risk-bearing contracts in Medicare Advantage are necessary to accelerate the spread of high quality care across the nation. Appropriate and equal treatment of risk relationships in Medicare Advantage are necessary for APMs to flourish for all Medicare beneficiaries," the letter states.
CAPG, a trade association representing accountable physician organizations, filed the letter on behalf of the physician groups. The letter asks CMS to create equal incentives for Medicare Advantage in its 2018 Final Rate Notice and Call Letter.
CAPG said CMS should begin integrating these provisions in MACRA's 2019 payment year.