Medicare’s Value-Based Transition Is at Risk Without Congressional Action, Say 550+ Healthcare Groups

More than 550 accountable care organizations, physician practices, hospitals, and healthcare stakeholders have delivered a clear and urgent message to congressional leaders: sustain Medicare’s transition to advanced alternative payment models (APMs) or risk derailing a decade’s worth of progress in value-based care.

In a May 29 joint letter to House Speaker Mike Johnson, Senate Majority Leader John Thune, House Democratic Leader Hakeem Jeffries, and Senate Democratic Leader Chuck Schumer, a coalition of 24 national provider associations pressed for legislative action to extend APM incentive payments and halt steep threshold increases that could force thousands of clinicians out of APM participation and back into the high-burden Merit-based Incentive Payment System (MIPS).

At the center of the request is the bipartisan Preserving Patient Access to Accountable Care Act (H.R. 786/S. 1460), which would preserve key financial supports that have enabled the success of APMs under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. Without immediate action, those incentive payments are set to expire, and qualifying thresholds will spike dramatically, making it far harder for clinicians to stay in these high-performing models.

According to the Health Care Transformation Task Force, ACOs have saved Medicare over $28 billion in the past decade while outperforming fee-for-service peers on a broad range of quality metrics. The Centers for Medicare & Medicaid Services (CMS) confirms these gains, pointing to consistent quality improvements in preventive care and chronic disease management.

The incentive structure built into MACRA has enabled over 500,000 clinicians to take on downside financial risk. CMS reports that more than 53 percent of Traditional Medicare beneficiaries are now aligned with providers who are accountable for cost and quality outcomes. This is not an experiment. It is the core pathway for Medicare’s modernization.

But that progress now faces a structural cliff. If incentive payments vanish and qualifying thresholds rise, many physician groups, especially those serving rural or medically complex populations, will be unable to sustain their investments in care coordination, transportation, nutrition services, and data infrastructure. These investments are often ineligible for traditional Medicare reimbursement but are essential to the success of population health models.

The consequences of a rollback are not theoretical. CMS has previously acknowledged that APMs have “spillover effects” that lower costs and improve care even for patients outside the models. Inversely, a forced migration back to MIPS could increase compliance costs, reduce care integration, and create administrative fatigue at a time when practices are already stretched thin.

In short, the loss of APM momentum would not just be a financial setback. It would be a regression in the national strategy for healthcare delivery reform.

The physician groups backing the appeal span every region and clinical setting, from large systems like Advocate Health, Mount Sinai, and Baylor Scott & White, to hundreds of independent practices, rural health clinics, and community-based ACOs. Their shared position is unequivocal: Congress must stabilize the policy environment that allows value-based care to scale.

Policymakers who are serious about reducing long-term Medicare spending, addressing chronic disease, and supporting provider sustainability cannot ignore the call. The expiration of APM incentives is not just a budget footnote. It is a fork in the road for the future of how care is financed and delivered in the United States.

A health system that rewards outcomes rather than volume is within reach, but only if federal lawmakers choose to protect and extend the tools that made that vision possible.