Policy Update: Physician Fee Cuts, the AAPM Bonus and the Medicare Advantage Proposed Rule

December 8, 2023

We hope you are all gearing up for some relaxing time with family and friends as we close out the year. It’s a nice time to look back at the progress we made in advocating for independent primary care and the ACO model, and the work ahead in 2024.

Physician Fee Cuts & the AAPM Bonus

Since our annual Hill Day this fall, Aledade and others in the ACO community continue to advocate for addressing physician fee schedule cuts finalized in the Physician Fee Schedule and the expiring AAPM incentive payment. While Congress has made moves in the right direction to address these priorities, it’s unlikely we will see an omnibus spending package this year. We expect Congress to take up physician fee cuts and the AAPM bonus in January and apply the fix retroactively to January 1. 

Advocacy Updates

This year, Aledade had the opportunity to testify in front of Congress and recommend steps policymakers could take to address anti-competitive behaviors in health care, and participate in Congressional briefings to educate lawmakers on the value of the ACO model. The Policy team brought legislators to physician policy committee meetings around the country, and had dialogues with elected officials and their staff on the potential policy solutions to prior authorization and increasing primary care investment. 

Policy changes in the 2024 PFS will help recruit and retain MSSP participants.
The 2024 PFS brings many positive changes to MSSP, signaling that CMS is focused on continuing to refine, grow, and evolve the flagship ACO program through making improvements in benchmarking, risk adjustment, quality reporting, and attribution. We look forward to working with CMS and the ACO community in 2024 to ensure that primary care clinicians in MSSP can be the quarterback of care that complex patients who might be seeing a variety of specialists need. As we gear up to advocate for policies in next year’s PFS, we are focusing on getting prospective population-based primary care payments for participants; improving quality reporting requirements; reducing administrative burden; and rolling out a full risk track in MSSP for those who want to take on more risk.

Call for Feedback: Medicare Advantage Proposed Rule Addresses Prior Authorization, Supplemental Benefits

We have the opportunity to provide CMS with comments on proposed policies in MA for 2025. CMS is proposing to require that MA plans have more transparency around prior authorization, specifically asking plans to show evidence that their prior authorization policies are not impeding care for patients with social risk factors. If you have any anecdotes or information you’d like us to share in our letter, we’d love to hear from you. CMS is also proposing that MA plans be required to have more transparency around the use of supplemental benefits and whether the benefits are improving health. Please let us know any feedback on these topics by Wednesday, December 20 ([email protected] or reach out to anyone on the team).

State Policy Corner 

  • Reminder: If you are a member of an Aledade State Policy Committee, please remember to fill out the end-of-the-year survey for your market. Your input helps us plan for next year. 
  • California: The DEADLINE for applications (link) for the third and FINAL round of grant funding to implement the state’s Data Sharing Agreement is December 15, 2023, at 11:59pm PT. We recommend you apply for this grant opportunity as soon as possible to ensure funding. If you have any questions about the application process or help navigating the application, please email [email protected].