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CMS: 359K Clinicians Participating in Four Alternative Payment Models in 2017

January 18, 2017
by Rajiv Leventhal
| Reprints

The Centers for Medicare & Medicaid Services (CMS) has announced that some 359,000 clinicians are confirmed to participate in four of CMS’s Alternative Payment Models (APMs) in 2017.

The Medicare Shared Savings Program, Next Generation Accountable Care Organization (ACO) Model, Comprehensive End-Stage Renal Disease (ESRD) Care Model (CEC) and Comprehensive Primary Care Plus (CPC+) Model all apply the concept of paying for quality and effectiveness of care given to patients in different healthcare settings, officials said. The CMS announcement today relates to the participants in each of these models for the 2017 calendar year.

With the announcement, participants in the four APMs are improving care delivery in 50 states, the District of Columbia, and Puerto Rico. In 2017, there are:

  • Over 359,000 clinicians participating in APMs
  • More than 12.3 million Medicare and/or Medicaid beneficiaries served
  • 572 ACOs across the Shared Savings Program, Next Generation ACO Model and CEC Model
  • 131 ACOs in a risk-bearing track, including in the Shared Savings Program, Next Generation ACO Model and CEC Model
  •  2,893 primary care practices participating in CPC+

CMS officials note that “Clinicians who participate in APMs are paid for the quality of care they give to their patients. APMs are an important part of the Administration’s effort to build a system that delivers better care and one in which clinicians work together to have a full understanding of patients’ needs. APMs also strive to ensure that patients are in the center of their care, and that Medicare pays for what works and spends taxpayer money more wisely resulting in a healthier country.”

In 2017, the Shared Savings Program welcomed 99 new participants and 79 renewing participants, bringing the total number of participants to 480 across 50 states, the District of Columbia, and Puerto Rico. CMS also recently announced a new Medicare ACO Track 1+ Model for 2018 that will test a payment design that incorporates more limited downside risk than is currently present in Tracks 2 or 3 of the Shared Savings Program in order to encourage more practices, especially small practices and small rural hospitals, to advance to performance-based risk.

Meanwhile, the Center for Medicare and Medicaid Innovation’s Next Generation ACO Model was designed to test whether strong financial incentives for ACOs can improve health outcomes and reduce expenditures for Medicare fee-for-service beneficiaries. Provider groups in this model assume higher levels of financial risk and reward than are available under the Shared Savings Program. In 2017, 28 new participants have joined the model, making the total number of 2017 participants 45. CMS also recently announced a new opportunity for participation in the Next Generation ACO Model beginning in 2018.

Further, the CEC Model— designed to identify, test, and evaluate new ways to improve care for Medicare beneficiaries with ESRD—received 24 new participants for a total of 47 participants in 2017. And, for CPC+, also an Innovation Center model, which is an advanced primary care medical home model that aims to strengthen primary care through a regionally-based multi-payer payment reform and care delivery transformation, CMS is partnering with 54 payers in 14 regions with 2,893 primary care practices which include over 13,000 clinicians, in 2017. CMS also recently announced CPC+ Round 2, with participation beginning in 2018.

CMS expects that by the 2018 performance year, 25 percent of clinicians in the Quality Payment Program will be participating in an Advanced APM and eligible to earn APM incentive payments.

“By listening to physicians and engaging them as partners, CMS has been able to develop innovative payment reforms that bring physicians back to the core practice of medicine—caring for the patient,” said Acting Administrator Andy Slavitt. “By reducing regulatory burden and paying for quality, CMS is offering solutions that improve the quality of services our beneficiaries receive and reduce costs, to help ensure the Medicare program is sustainable for generations to come.”

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