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CMS Expands Advanced APM Opportunities as Stakeholders Push for Track 1+ Details

December 15, 2016
by Rajiv Leventhal
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The Centers for Medicare & Medicaid Services (CMS) has announced more opportunities for clinicians to join Advanced Alternative Payment Models (APMs) under the Quality Payment Program within the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Beginning in January and February 2017, CMS will now officially open applications for new rounds of two CMS Innovation Center models for the 2018 performance year—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.

In October, shortly after the MACRA final rule was released, CMS made a similar announcement to the one today, creating more opportunities for clinicians to qualify as APMs. What’s new this time around appears to be the official inclusion of CMS opening applications for CPC+ and Next Generation ACO participants.

With these new opportunities, CMS expects that by the 2018 performance period, 25 percent of clinicians in the Quality Payment Program would be a part of these advanced models and may be eligible to earn incentive payments., the agency said in a Dec. 15 press release.

Starting next year, the Quality Payment Program will reform Medicare payments for more than 600,000 clinicians across the country by promoting quality patient care while controlling escalating costs through the Merit-Based Incentive Payment System (MIPS) and incentive payments for advanced APMs. Clinicians that have sufficient participation in an advanced APM will be exempt from MIPS reporting requirements and payment adjustments.

To recap, for the 2017 performance year, under the Quality Payment Program, clinicians may earn a 5 percent incentive payment through sufficient participation in the following Advanced APMs:

    Comprehensive ESRD Care Model (Large Dialysis Organization (LDO) arrangement)

    Comprehensive ESRD Care Model (non-LDO two-sided risk arrangement)

    CPC+

    Medicare Shared Savings Program - Track 2

    Medicare Shared Savings Program - Track 3

    Next Generation ACO Model

    Oncology Care Model (two-sided risk arrangement)

In 2018, CMS said it anticipates that clinicians may also earn the incentive payment through sufficient participation in the following new and existing models:

    Medicare ACO Track 1+ Model

    New voluntary bundled payment model

    Comprehensive Care for Joint Replacement Payment Model (Certified Electronic Health Record Technology (CEHRT) track)

    Advancing Care Coordination through Episode Payment Models Track 1 (CEHRT track)

These lists will continue to change and grow as more models are proposed and developed in partnership with the clinician community and with input from the Physician-Focused Payment Model Technical Advisory Committee, CMS said.

In the MACRA final rule, CMS announced a new advanced APM in 2018—the above-mentioned ACO Track 1+, which has lower levels of risk than other ACOs. To this end, the Charlotte, N.C.-based Premier healthcare alliance penned a Dec. 15 letter to federal officials, jointly with nine other healthcare associations, expressing support for CMS moving forward to create the Track 1+ ACO model. The letter also recommends specific elements of the new ACO model’s design.

Premier said that the joint comments represent the collective views of organizations representing physicians, hospitals, medical group practices, academic medical centers and nearly all existing Medicare Shared Savings Program (MSSP) ACOs. In the comments, signers stressed that Track 1+ is an important next step to ensure the long-term viability of the ACO model. Premier said that “many key details of Track 1+ are yet to be determined, and the organizations submitting this letter are actively engaged in efforts to shape this ACO model in a way that retains existing participants while attracting new ones to expand the success of the program and reach more beneficiaries nationwide.”

Clif Gaus, president and CEO of the National Association of ACOs (NAACOS), noted, “With growing calls for ACOs to take on risk, it’s important to recognize that 90 percent of Medicare ACOs remain in Track 1 due to the very high levels of risk in the current two-sided models (MSSP Track 2, 3 and the Next Generation ACO Model), which require significantly more risk than what the vast majority of ACOs can bear. Track 1+ would provide a much-needed choice for ACOs and create a glide path to assuming risk. We and the other co-signers look forward to continuing to work closely with CMS to develop the details of Track 1+.”

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