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New push for value-based care bonus extension

Dec 15, 2022
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Illustration: Sarah Grillo/Axios

Value-based care advocates are pulling out all the stops to get the 5% advanced alternative payment model participation bonus extended before it expires at the end of the year.

Why it matters: Without the bonus, providers have less incentive to participate in value-based care programs, which some providers and policymakers believe are necessary to keep the Medicare program solvent.

  • “The industry does respond to incentives,” said Aisha Pittman, NAACOS senior vice president of government affairs.

Driving the news: Sens. Sheldon Whitehouse and John Barrasso released a bill Wednesday to extend the bonus for two more years. (A similar bill was introduced in the House in 2021.)

Between the lines: Introducing bipartisan legislation in the Senate at this point in the year shows that lawmakers haven’t given up on including the extension in the end-of-year omnibus bill.

What to watch: The CBO score for a two-year bonus extension came in higher than expected, but there are ways to bring the cost of the policy down. The most likely fix is to extend the bonus for just one year.

  • Changing the percentage of the bonus and narrowing the scope of who qualifies could also be on the table, lobbyists said.
  • “The question is whether there's time to kind of craft a really specific bonus policy at this late hour, if you're talking about who qualifies and how you figure that out and get technical assistance from CMS,” said Mara McDermott, vice president at McDermott+Consulting and executive director of the Value Based Care Coalition.

The other side: The bonus is paid out to providers two years after the qualifying performance year. “There is time, if needed, that we could revisit this at the beginning of the year. We're hoping not to be there,” Pittman said.

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