While the goal was to give most doctors a chance to transition into APMs, the Center for Medicare & Medicaid Innovation “models implemented to date often have steep financial risk requirements, lack funding needed to successfully redesign care delivery, and are usually only available in selected regions,” the AMA explains.

Now nine years since MACRA’s passage, it is clear that critical changes are needed to enhance physician participation in APMs, improve patient outcomes and cut unnecessary Medicare spending.

Specifically, Congress needs to take these steps.

Reauthorize crucial incentive payments that help physicians participate in Advanced APMs before they expire at the end of 2024. Physicians who participate in Advanced APMs in 2024 will receive the bonus payments in 2026.

Make APM revenue thresholds that need to be met to even qualify for earning the incentive payments more flexible and realistic, thus preventing abrupt increases scheduled to take effect in 2025.

Update criteria for adopting and expanding Medicare APMs. That’s because the criteria for achieving Medicare savings quickly led to the termination of multiple types of payment models and limited adoption amongst specialty physicians. Meaningful pathways are needed for APM proposals developed by stakeholders, especially those endorsed by the Physician-focused Payment Model Advisory Committee, to be implemented in Medicare. To date, not a single PTAC endorsed model endorsed by the advisory committee has been tested by Medicare.