Advocacy for Medicare Value-Based Care Reinstated by AMA
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The American Medical Association (AMA) and other organizations successfully advocated for the reinstatement of a Medicare incentive, promoting value-based care after its lapse in the 2024 performance year. The recently enacted H.R. 7148, known as the Consolidated Appropriations Act of 2026, includes provisions for a 3.1% bonus for physicians engaging in Medicare alternative payment models (APMs), set to take effect for the 2026 performance year.
Physicians participating in APMs can anticipate receiving this bonus in the 2028 payment year, based on the traditional timeline established under the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015 (MACRA). This renewal marks a key achievement secured through the AMA’s advocacy, as highlighted in the "AMA Advocacy Impact Report."
The AMA National Advocacy Conference, held in Washington, D.C., serves as a platform for physicians and medical leaders to engage with Congress and federal agencies on critical health care issues. The focus is on advancing value-based care, with APMs playing an integral role by emphasizing quality and cost-management accountability to enhance clinical outcomes over service volume.
To qualify for the reinstated incentive, physicians must meet revised revenue thresholds associated with APM participation. The new legislation adjusts this requirement from 75% to 50%, making it more accessible. This restored incentive aims to boost participation in APMs, fostering efforts to control costs and improve care quality through innovative care models like accountable care organizations (ACOs), which already report significant savings.
More than half a million health professionals currently engage in APMs, yet expanding participation remains a key priority. Financial incentives and regulatory adjustments, such as exemption from the Merit-based Incentive Payment System (MIPS) reporting, are vital for encouraging broader adoption. An AMA-endorsed letter, backed by physician groups and health entities, underscores the necessity of continued progress towards value-based care by highlighting how financial uncertainties can impede managing complex patient populations, especially in underserved regions.
The AMA offers resources to explore the transition to value-based care further, encouraging participation in reforming Medicare practices for the benefit of providers and patients alike. Subscribers to AMA resources can receive ongoing updates on medical policy and professional developments, staying informed on critical changes within the insurance industry.