CMS Updates Areas Subject to Advanced Alternative Payment Model

Added on Nov 17, 2016

CMS Updates Areas Subject to Advanced Alternative Payment Model
Industry Edge November 2016

The Centers for Medicare & Medicaid Services (CMS) has announced plans to broaden opportunities for clinicians to participate  in Advanced Alternative Payment Models by retrofitting existing models to qualify as Advanced APMs and using the CMS Innovation Center to create new models, including those recommended by the Physician-Focused Payment Model Technical Advisory Committee.

One opportunity CMS is considering is an ACO Track 1+ model that would be a new Advanced APM in 2018 with lower risk levels than those currently available to Medicare ACOs. CMS’s Quality Payment Program final rule, which it issued last month, eases the risk criteria for Advanced APMs from the proposal, allowing a broader range of future models, including those tailored to small practices or specialties.

According to CMS estimates, approximately 70,000 to 120,000 clinicians will participate in the following Advanced APMs and qualify for a 5% incentive payment for the 2017 performance year:
  • Comprehensive ESRD Care Model (Large Dialysis Organization [LDO] arrangement)
  • Comprehensive ESRD Care Model (non-LDO arrangement)
  • Comprehensive Primary Care Plus (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)

CMS plans to publish a final list prior to January 1, 2017.

For the 2018 performance year, CMS estimates that more than 125,000 clinicians will participate in Advanced APMs and qualify for the 5% incentive payment, and it anticipates that the following models will be Advanced APMs (in addition to those listed above):

  • 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)

CMS plans to publish a final 2018 performance year Advanced APM Model list before January 1, 2018, and anticipates reopening applications for new practices and payers in CPC+ and new participants in the Next Generation ACO model for the 2018 performance year.