- More than 359,000 clinicians are set to take part in one of four of Alternative Payment Models (APMs) as part of the Quality Payment Program, the federal agency announced midweek.
Beyond APMs, the Quality Payment Program also includes the Merit-Based Incentive Program (MIPS) as a pathway for eligible clinicians (i.e., Medicare providers) to receive incentives as part of MACRA implementation contingent on their performance on value-based care objectives.
As part of the move toward value-based care, APM participants are paid according to the quality of care they deliver to patients as opposed to the quantity of treatments they administer. Participants in Advanced APMs will receive an incentive payment equaling 25% of their Medicare B payments or see 20% of their Medicare patients through their Advanced APM.
CMS contends these Alternative Payment Models will improve quality of care, lower overall healthcare industry expenditure, and prime the industry to make the full transition to value-based care.
“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.”
Programs tailored toward the new model of administering care include The Medicare Shared Savings Program (MSSP), Next Generation Accountable Care Organization (ACO) Model, Comprehensive End-Stage Renal Disease (ESRD) Care Model (CEC), and Comprehensive Primary Care Plus (CPC+), the latter of which involves 2,893 primary care practices alone.
The programs have already served over 12.3 million Medicare and Medicaid beneficiaries to date.
The APMs include participants in all 50 states, the District of Columbia, and Puerto Rico. As of the start of 2017, there are over 395,000 clinicians involved in the four payment models and 572 ACOs across MSSP, Next Generation ACO Model, and CEC Model.
Of the ACOs involved in the aforementioned APMs, 131 are on a risk-bearing track.
Each of the four programs concerns a different branch of the healthcare industry that facilitate providers’ ability to meet requirements of the Quality Payment Program (QPP) and strengthen the effort toward industry-wide value-based care.
Established by the Affordable Care Act, the Medicare Shared Savings Program is instrumental in carrying out Medicare delivery system reform initiatives. ACOs participating in this payment model primarily involve fee-for-service Medicare beneficiaries. Presently MSSP consists of 480 participants across the country.
The Center for Medicare and Medicaid Innovation’s Next Generation ACO Model tests the value of financial incentives as motivation for accountable care organizations to improve quality of care and lower costs for Medicare fee-for-service beneficiaries.
The CMMI CEC Model evaluates strategies to improve care for specific Medicare beneficiaries with ESRD. According to the federal agency, dialysis clinics, nephrologists, and other clinicians work in collaboration in an ERST Seamless Care Organization responsible for ensuring coordinated care for beneficiaries
Finally, CPC+ is intended to serve an innovation center for improving primary care through regional multi-payer payment reform and care delivery transformation. CPC+ involves 54 payers across 14 regions and 13,000 clinicians.
“These models demonstrate CMS’s commitment to partner with providers to improve care for patients,” said Patrick Conway, MD, Acting Principal Deputy Administrator and Director of the CMS Innovation Center. “My mother and over 12 million other Medicare beneficiaries are now cared for by doctors and other clinicians in payment models that focus on better health outcomes and coordinated, high quality care.”