CMS Announces Additional Opportunities for Clinicians Under the Quality Payment Program

December 15th, 2016 - Brittney Murdock, CPC
Categories:   Medicare   MIPS|PQRS|PQRI  
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Today, the Centers for Medicare & Medicaid Services (CMS) announced more new opportunities for clinicians to join Advanced Alternative Payment Models (APMs) to improve care and earn additional incentive payments under the Quality Payment Program, which implements the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Beginning in January and February 2017, CMS will 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.  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 CMS Innovation Center, which the Affordable Care Act created, takes best practices from physicians and other clinicians and promotes them across the nation,” said CMS Acting Administrator Andy Slavitt. “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.”

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, we anticipate 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.

“We are excited to build on the progress of comprehensive primary care, the foundation of a better health system,” said Dr. Patrick Conway, 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.”

This is part of the Administration’s effort to build a system that delivers better care, one in which clinicians work together and have a full understanding of patients’ needs, Medicare pays for what works and spends taxpayer money more wisely, and patients are in the center of their care, resulting in a healthier country.

 For more information about Next Generation ACO Model, please visit: https://innovation.cms.gov/initiatives/Next-Generation-ACO-Model/

For more information about CPC+, please visit: https://innovation.cms.gov/initiatives/comprehensive-primary-care-plus/

For more information about Medicare Medicaid ACOs, please visit: https://innovation.cms.gov/initiatives/medicare-medicaid-aco-model/

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