CMS Increases Options for Alternative Payment Models

Clinicians will now have more opportunities to earn the incentive payment.

The US Centers for Medicare and Medicaid Services (CMS) has recently announced additional opportunities for healthcare providers to join the Advanced Alternative Payment Models.

The organization’s Innovation Center created payment models to improve the quality of care received by the patient, and provide clinicians with a potential incentive payment under the Quality Payment Program.

The program, created under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), rewards providers for high-quality, patient-centered care.

With more healthcare providers participating in the payment models, the benefits of the coordinated high-quality care will be received by more Medicare beneficiaries, according to a press release from CMS.

“Every day, the CMS Innovation Center is improving the future of Medicare by testing innovative care models across the country,” said CMS Acting Administrator Andy Slavitt. “Now, thanks to the bipartisan MACRA, clinicians have more opportunities and motivation to join these evidence-based approaches, which aim to improve care quality while creating cost savings.”

CMS is re-opening applications for new providers in the Comprehensive Primary Care Plus model, as well as for the Next Generation Accountable Care Organization model for 2018. Additionally, they are also announcing that the Oncology Care Model will be available for 2017.

Under the payment program, providers can earn an incentive payment of 5% through participation in the following:

  • Comprehensive End-Stage Renal Disease Care Models
  • Comprehensive Primary Care Plus
  • Medicare Shared Savings Program Accountable Care Organizations - Track 2 or 3
  • Next Generation Accountable Care Organization Model
  • Oncology Care Model (2-sided risk arrangement)

The CMS is also encouraging providers to participate in the following to earn the incentive payment:

  • Accountable Care Organization Track 1+
  • New voluntary bundled payment model
  • Comprehensive Care for Joint Replacement Payment Model
  • Advancing Care Coordination through Episode Payment Models Track 1

They expect that these lists will continue to grow as additional models are created and implemented in different practices. An estimated 70,000 to 120,000 clinicians will be participating in the Advanced Payment Models, and will be eligible to receive the incentive payment for 2017, according to the CMS.

“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 Patrick Conway, MD, deputy administrator of CMS. “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.”