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Tags Posts tagged with "advanced alternative payment models"

advanced alternative payment models

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The Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2018 updates to the Quality Payment Program (QPP) via a final rule with comment period.

Established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the QPP has the goal to incentivize physicians and other eligible clinicians by rewarding value and outcomes through either the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).

Some of the provisions contained in the final rule include:

  • Weighting the MIPS cost performance category to 10 percent of total MIPS final score, and the Quality performance category to 50 percent;
  • Raising the MIPS performance threshold to 15 points in Year 2 (from 3 points in the transition year);
  • Awarding up to 5 bonus points on MIPS final score for treatment of complex patients;
  • Adding 5 bonus points to the MIPS final scores of small practices;
  • Adding Virtual Groups as a participation option for MIPS;
  • Issuing an interim final rule with comment period for extreme and uncontrollable circumstances where clinicians can be automatically exempt from these categories in the transition year without submitting a hardship exception application if they have been affected by the hurricanes that occurred during the 2017 MIPS performance period;
  • Providing more detail on how eligible clinicians participating in selected APMs (known as MIPS APMs) will be assessed under the APM scoring standard; and
  • Creating additional flexibilities to allow clinicians to be successful under the All Payer Combination Option, which will be available beginning in performance year 2019.

The final rule will be published in the November 16, 2017 Federal Register, with comments due by January 1, 2018.

Additional information is available in a fact sheet and an Executive Summary document. In addition, CMS will conduct an overview webinar on Tuesday, November 14, 2017, from 1:00 pm to 2:30 pm. To participate in this webinar, registration is required.

The Medicare Payment Advisory Commission (MedPAC) has released its June 2017 Report to Congress: Medicare and the Health Care Delivery System. This report includes, among other topics, a chapter focusing on implementing a unified payment system for post-acute care. Specifics in this chapter includes implementing a post-acute care prospective payment system (PAC PPS) beginning in 2021 with a three-year transition, lower aggregate payments by five percent, absent prior reductions to the levels of payments, start to align setting-specific regulatory requirements, and periodically revise and rebase payments to keep payments aligned with the cost of care.

Some of the topics included in the other chapters include Medicare Part B drug payment policy issues; redesigning the merit-based incentive payment system (MIPS) and strengthening advanced alternative payment models, etc. MedPAC also released a fact sheet on the report.

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On November 4, 2016, the Centers for Medicare and Medicaid Services (CMS) published the final rule with comment period for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) as the payment program that will replace the Sustainable Growth Rate methodology. The rule finalizes MACRA’s Quality Payment Program, whose primary goal is to reduce administrative burden on physicians to allow them to focus on improving care, promote the adoption of value-based care, and smooth the transition to these new models of care. The final rule establishes guidelines for Medicare health care providers to participate in either the Advanced Alternative Payment Models (APMs) or the Merit-based Incentive Payment System (MIPS), which consolidates components of three existing programs: the Physician Quality Reporting System, the Physician Value-based Payment Modifier, and the Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals. According to CMS, the Advanced APMs pathway provides clinicians with the opportunity to be paid more for better care and investments that support patients by reducing existing requirements, while still emphasizing and rewarding quality care. Participants in the advanced APMs must meet the following requirements:

  • Be part of CMS Innovation Center models, Shared Savings Program tracks, or certain federal demonstration programs;
  • Use certified EHR technology;
  • Base payments for services on quality measures comparable to those in MIPS; and
  • Be a medical home model expanded under innovation center authority or require participants to bear more than nominal financial risk for losses.

The final rule has a 60-day comment period, with comments due by Monday, December 19, 2016. RCPA will be offering a webinar in the near future on the details of the final rule, hosted by the American Medical Rehabilitation Providers Association (AMRPA). The date and time will be released soon.