Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

2018 Advanced APM Options Added to Quality Payment Program

CMS will re-open CPC+ and Next Generation ACO applications in 2017 for Advanced Alternative Payment Model participation in the 2018 Quality Payment Program.

- Eligible clinicians now have more opportunities to earn value-based incentive payments by participating in the Advanced Alternative Payment Model track of the Quality Payment Program in 2018, according to a recent CMS announcement.

Additional Advanced Alternative Payment Models are available to eligible clinicians for 2018 participation in the Quality Payment Program

Starting in January 2017 to February 2017, CMS will reopen applications for the Comprehensive Primary Care Plus (CPC+) and the Next Generation Accountable Care Organization (ACO) models. Approved participants will start their performance period in 2018.

By adding more Advanced Alternative Payment Model options for future participation, CMS anticipates about 25 percent of eligible clinicians in the Quality Payment Program to be part of one of the approved models by 2018.

“We are excited to build on the progress of comprehensive primary care, the foundation of a better health system,” stated Patrick Conway, MD, CMS Acting Deputy Administrator. “Our Next Generation ACO model is the future of accountable care where providers take on full accountability for total cost of care and quality for a population of patients. These models allow doctors and other clinicians to practice the way they want to, including spending more time with patients, and provide coordinated, patient-centered care to all beneficiaries.”

With the Quality Payment Program set to launch on Jan. 1, 2017, eligible clinicians can only earn a five percent value-based incentive payment through sufficient participation in the following approved Advanced Alternative Payment Models in 2017:

• Comprehensive End-Stage Renal Disease (ESRD) Care Model (Large Dialysis Organization structure)

• Comprehensive ESRD Care Model (Non-Large Dialysis Organization two-sided financial risk structure)

• CPC+

• Medicare Shared Savings Program Track 3

• Next Generation ACO Model

• Oncology Care Model (two-sided financial risk structure)

CMS reported that the first round of the five-year CPC+ will begin in January 2017, but the federal agency plans to offer a second round by January 2018. Practices located in Round 2 CPC+ areas will be able to apply for model participation in late spring or early summer of 2017.

Payers interested in partnering with CMS on the CPC+ Round 2 can also submit proposals to the federal agency by mid-February 2017. CMS will accept proposals from payers in ten new regions as well as new payers in the existing 14 CPC+ regions.

Eligible clinicians can also apply for the Next Generation ACO model starting in January 2017. CMS will post request for applications in the new year and interested providers can send a letter of intent starting in February 2017.

All final Next Generation ACO applications for the 2018 performance year will be due in May 2017.

CMS noted that the re-opened application opportunity will be the final round of Next Generation ACO applications and selected ACOs will not be able to defer participation in the model.

In addition to re-opening applications for existing models, CMS expects to add the following alternative payment models to the approved list by 2018:

• Medicare Shared Savings Program ACO Track 1+ Model

• New voluntary bundled payment model

• Comprehensive Care for Joint Replacement Payment Model (Certified EHR arrangement)

• Advancing Care Coordination through Episode Payment Models Track 1 (Certified EHR arrangement)

CMS has not announced the development of the Medicare Shared Savings Program ACO Track 1+ Model or the new voluntary bundled payment model. Although, the final MACRA implementation rule stated that CMS is exploring an additional Medicare ACO track for 2018 that incorporates more downside financial risk than the Medicare Shared Savings Program Track 1, but less than Tracks 2 and 3.

Additionally, the announcement stated that eligible clinicians should expect more Advanced Alternative Payment Model options as the CMS Innovation Center develops care delivery and payment programs with the help of the clinical community and the Physician-Focused Payment Model Technical Advisory Committee.

“The CMS Innovation Center, which the Affordable Care Act created, takes best practices from physicians and other clinicians and promotes them across the nation,” stated Andy Slavitt, CMS Acting Administrator. “Thanks to the bipartisan MACRA, more clinicians and their patients will benefit from being a part of these models. That’s good for the future of Medicare, the health of beneficiaries, and the satisfaction of clinicians with their work.”

Slavitt similarly praised the CMS Innovation Center earlier this month. He told healthcare leaders at the inaugural MACRA MIPS/APM Summit that the CMS Innovation Center is key to advancing value-based care as well as MACRA implementation.

The center could be eliminated if the Affordable Care Act is repealed without replacement legislation upholding the federal agency’s innovation arm.

Without the CMS Innovation Center, he said that the healthcare industry would have “a much narrower path with fewer specialty options and approaches, which take in patient and physician feedback.”

Medicare and private payers would also fall out of alignment with value-based care, causing less patients to have access to improved care methods.

For now, the CMS Innovation Center expressed its commitment to expanding and developing alternative payment models, especially for the Quality Payment Program. In the recent announcement, the center stated that it would support innovative payment and care delivery models, engage stakeholders in the development process, and assess alternative payment models.

“We look forward to continuing to work with our many stakeholders to achieve better care for patients, better health for our communities, and lower costs through improvement for our healthcare system,” the announcement stated.

Dig Deeper:

Understanding the Value-Based Reimbursement Model Landscape

Top 5 Facts to Know about MACRA Alternative Payment Models

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