MACRA update: More advanced APM opportunities to open

CMS is offering additional opportunities for physicians and other clinicians to join advanced Alternative Payment Models beginning in 2017 and 2018, the agency announced Tuesday.

The advanced Alternative Payment Model is the more lucrative of two options under the Medicare Access and CHIP Reauthorization Act, a payment system for Medicare physician fees that replaces the controversial sustainable growth rate formula.

CMS plans to offer the Oncology Care Model with two-sided risk as a qualifying advanced APM beginning in 2017. The agency also said it plans to reopen applications for the Comprehensive Primary Care Plus model and the Next Generation ACO model for the 2018 performance year.

"With these new opportunities, CMS expects that by the 2018 performance period, 25 percent of clinicians in the Quality Payment Program will earn incentive payments by being a part of these advanced models," Patrick Conway, MD, Deputy Administrator of CMS, said in a statement. "Thanks to MACRA and the Innovation Center, we're striving to see more Medicare patients benefit from better care when they visit their doctor for a knee replacement, receive cancer treatment or have a coordinated care team manage their complex conditions."

Physicians who participate in Medicare will be required to submit at least some performance data next year to avoid a penalty under MACRA. This data will determine payment adjustments beginning in 2019. Physicians who qualify as an advanced APM will avoid some reporting requirements and be eligible for a 5 percent lump sum bonus.

The following models will qualify as advanced APMs in 2017.

  • Comprehensive End Stage Renal Disease Care Model, Large Dialysis Organization and non-LDO arrangement
  • Comprehensive Primary Care Plus
  • Medicare Shared Savings Program ACOs, Tracks 2 and 3
  • Next Generation ACO Model
  • Oncology Care Model, two-sided risk arrangement

CMS expects to add the following models as advanced APMs in 2018.

  • ACO Track 1+
  • New voluntary bundled payment model
  • Comprehensive Care for Joint Replacement Payment Model, Certified Electronic Health Record Technology track
  • Advancing Care Coordination through Episode Payment Models Track 1, CEHRT track


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