From the December 2016 issue of HealthCare Business News magazine
Advanced APMs
In 2017, under the QPP, 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 arrangement)
• CPC+
• Medicare Shared Savings Program ACOs — Track 2
• Medicare Shared Savings Program ACOs — Track 3
• Next Generation ACO Model
• Oncology Care Model (two-sided risk arrangement)
In 2018, it’s expected that physicians may also earn the incentive payment through sufficient participation in the following models:
• ACO Track 1+
• 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 the Physician-Focused Payment Model Technical Advisory Committee. To qualify as an Advanced APM participant, an eligible clinician must either:
• Receive at least 25 percent of the clinician’s payments for Medicare Part B-covered professional services through an Advanced APM, or
• See at least 20 percent of the clinician’s Medicare patients through an Advanced APM
The final rule excludes small practices from reporting requirements in 2017 due to the low-volume threshold, which has been set at less than or equal to $30,000 in Medicare Part B-allowed charges or less than 100 Medicare patients. It provides $100 million in education and technical assistance to small and rural practices in 2017.
Why is MACRA so critical to the U.S. health care system? According to the Congressional Budget Office’s most recent long-term projections — which include the estimated effects of MACRA — net Medicare spending will grow from 3 percent of GDP in 2015 to 4.2 percent of GDP in 2030, 5.1 percent in 2040 and 5.9 percent in 2050.
About the author: Dr. Amy Nguyen Howell is a board-certified family practice physician. She oversees all clinical programs at CAPG and supports advocacy work in Sacramento, Calif., and Washington D.C. CAPG’s Guide to Alternative Payment Models offers case studies that highlight CAPG member experiences with a range of APMs, from bundled payments to capitated, coordinated care.Back to HCB News
