Recent Survey Finds 2021 QP Thresholds May Impede Medicare’s Move to Value-Based Payment

The National Association of Accountable Care Organizations (NAACOS) recently conducted a survey of ACOs requesting feedback on the Advanced Alternative Payment Model (APM) bonus and Qualifying APM Participant (QP) thresholds. 216 responses came in from 116 ACOs around the country.

Overall, the survey found that the Advanced APM bonus has “meaningfully supported” ACOs moving to risk-based models and has helped to fund patient-focused initiatives (i.e., care coordination efforts).

However, of the respondents, more than 90% reported concerns that they would not meet the QP thresholds to secure important incentive payments for participating in risk-based APMs, with 78% of respondents believing it would be either difficult or very difficult. In 2021, the QP thresholds are scheduled to jump to higher and “unrealistic” levels. When NAACOS reviewed the data behind the survey, it showed that those concerns are valid, as 96% of the 216 respondents would not meet the 2021 thresholds based on their 2020 performance. If ACOs fail to receive the bonus, that could threaten Medicare’s move to value-based payment.

According to NAACOS, to maintain the incentive and fix this potential problem for ACOs and other Advanced APM participants, Congress should take quick action and address the QP thresholds. The 5% bonus that clinicians can earn by meeting Qualifying APM Participant (QP) thresholds was set through the bipartisan Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.

In 2017, roughly 90 percent of the clinicians who met the QP threshold did so by participating in an ACO. The QP thresholds are supposed to increase every two years, but the levels to which they rise in 2021 are unrealistic. The average QP score for Medicare ACOs was 44 percent in 2017 and 2018, but the threshold is currently set to jump to 75 percent in 2021. However, because Medicare patients choose where they receive care, providers have minimal to no control over their thresholds.

“These bonuses are critical to Medicare’s value movement,” said Clif Gaus, Sc.D., NAACOS president and CEO. “The current thresholds are a challenge for many ACOs. To increase them again in 2021 would put the incentive out of reach for nearly everybody. Congress intended to shift Medicare payment to a value-based approach, and we are seeing the benefits of that transformation through improved patient care and reduced costs. We need Congress to correct these thresholds to prevent the value movement from stalling.”

An overwhelming amount of survey respondents (84%) said the bonus has been “extremely important” to their ACO. When asked how their ACO has used the Advanced APM bonus, the most popular answers were investing in ACO initiatives such as care coordination or data analytics (58 percent) and supporting their ACO’s move to a risk-based model (53 percent). Recruiting new providers and paying existing providers bonuses were also popular responses.

NAACOS points out that Medicare spending will soon top $1 trillion per year and as lawmakers look for ways to lower the rate of spending growth, ACOs have become the leading mechanism. In 2019, Shared Savings Program ACOs collectively saved Medicare $2.6 billion, and $1.2 billion after accounting for shared savings bonuses and shared loss payments.