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CMS announces additional opportunities for clinicians to join innovative care approaches under the Quality Payment Program

By CMS.gov
October 25, 2016

Today, the Centers for Medicare & Medicaid Services (CMS) announced new opportunities for clinicians to join Advanced Alternative Payment Models (APMs) developed by the CMS Innovation Center to improve care and potentially earn an incentive payment under the Quality Payment Program created through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The Quality Payment Program rewards clinicians with sufficient participation in Advanced APMs that align incentives for high-quality, patient-centered care. By giving more clinicians the opportunity to participate in these models, today’s announcement will extend the benefits of high-quality, coordinated care to more Medicare beneficiaries.

“Every day, the CMS Innovation Center is improving the future of Medicare by testing innovative care models across the country,” said CMS Acting Administrator Andy Slavitt. “Now, thanks to the bipartisan MACRA, clinicians have more opportunities and motivation to join these evidence-based approaches, which aim to improve care quality while creating cost savings.”

CMS is announcing that it expects to re-open applications 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 for the 2018 performance year. In addition, CMS is announcing that the Innovation Center’s Oncology Care Model with two-sided risk will now be available in 2017, which will qualify the model as an Advanced APM beginning in the 2017 performance year.

In 2017, 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 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, we anticipate that clinicians 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.

“With these new opportunities, CMS expects that by the 2018 performance period, 25 percent of clinicians in the Quality Payment Program will earn incentive payments by being a part of these advanced models,” said Dr. Patrick Conway, Deputy Administrator of CMS. “Thanks to MACRA and the Innovation Center, we’re striving to see more Medicare patients benefit from better care when they visit their doctor for a knee replacement, receive cancer treatment, or have a coordinated care team manage their complex conditions.”

For more information, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-10-25.html 


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