Doctors in Medicare Advantage Also Want That 5 Percent Bonus


Should doctors in Medicare Advantage contracts be entitled to the bonuses offered doctors in joint medical arrangements under traditional Medicare?

That’s the question the Centers for Medicare & Medicaid Services is asking the public.

Doctors in traditional Medicare who join advanced alternative payment models are exempt from having to report quality measures to the Medicare agency. But better still, if the payment model meets the agency’s criteria, participants get a 5 percent incentive payment on their Medicare Part B claims.

But doctors who are in certain Medicare Advantage managed care networks contend that they have similar obligations and are at risk for monetary losses like doctors in advanced alternative payment models. They just don’t get the 5 percent bonus that was designed to encourage doctors in traditional Medicare to join an alternative payment model, such as a medical home.  The goal of the model is to pay docs for the value, not volume, of their services.

The alternative payment model system was created under the Medicare Access and CHIP Reauthorization Act (MACRA), the 2015 physician payment law that took effect Jan. 1.

The Medicare agency may be opening the door a crack to the Medicare Advantage doctors’ arguments.

A proposed rule issued in June said the Medicare agency is considering using doctors’ contractual arrangements with Medicare Advantage plans to count toward their qualifications to be part of an advanced alternative payment model. CMS wants to hear from you by Aug. 21 about whether it should use its waiver and demonstration authorities to do so.

Got a couple of minutes? Read my full story on the interplay between Medicare Advantage and MACRA here:  https://www.bna.com/door-opening-medicare-n73014463099.

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