WASHINGTON — Physicians who are wondering if they can fit into any of the Advanced Alternative Payment Models (APMs) under the Medicare Access and CHIP Reauthorization Act (MACRA) will now have a few more options to consider.
The Centers for Medicare & Medicaid Services (CMS) “expects to re-open applications for new practices and payers in the Comprehensive Primary Care Plus (CPC+) model and new participants in the Next Generation Accountable Care Organization (ACO) model for the 2018 performance year,” the agency said Tuesday in a press release. “In addition, CMS is announcing that the Innovation Center’s Oncology Care Model with two-sided risk will now be available in 2017, which will qualify the model as an Advanced APM beginning in the 2017 performance year.”
“Every day, the CMS Innovation Center is improving the future of Medicare by testing innovative care models across the country,” CMS acting administrator Andy Slavitt said in the release. “Now, thanks to … MACRA, clinicians have more opportunities and motivation to join these evidence-based approaches, which aim to improve care quality while creating cost savings.”
Under the APM program, clinicians meeting specific requirements would earn incentive payments of approximately 5% for 5 years in a lump-sum payment every year from 2019 to 2024.
Those ineligible for the advanced APMs will be assigned to a default framework, the Merit-Based Incentive Payment System (MIPS). From 2019 to 2024, these providers would receive small bonuses or penalties based on their ability to meet a series of metrics across four categories: quality improvement, performance, resource use, and appropriate use of electronic health records. Physicians must start collecting data on their metrics in 2017 in order to avoid a payment penalty.
In 2017, physicians will be able to participate in a variety of APMs in order to earn the incentive payment, including the Comprehensive ESRD [end-stage renal disease] Care Model, CPC+, Medicare Shared Savings Program ACOs (tracks 2 and 3), the Oncology Care Model, and the Comprehensive Care for Joint Replacement payment model, CMS said.
“With these new opportunities, CMS expects that by the 2018 performance period, 25% of clinicians in the Quality Payment Program will earn incentive payments by being a part of these advanced models,” said CMS deputy administrator Patrick Conway, MD, said in the press release.
Also on Tuesday, The Health Care Payment Learning and Action Network, a group organized by the Department of Health and Human Services, released a report showing that in 2015, 38% of dollars spent on healthcare by commercial insurers, Medicaid, and Medicare Advantage were tied to quality metrics, alternative payment models, or population-based health measures.
“This report shows the meaningful progress we’ve made to improve quality and lower costs,” Marilyn Tavenner, president and CEO of America’s Health Insurance Plans, a trade group for health insurers, said in a statement. “Health plans, doctors, hospitals, businesses, and public programs are all changing, all collaborating â and all improving the way we deliver care.”