CMS Releases List of Additional Advanced APM’s and Announces Vermont’s All-Payer ACO

Practice area:

On the heels of the release of its final rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA), the Centers for Medicare and Medicaid Services (CMS) released a list of additional opportunities for joining Advanced Alternative Payment Models (APMs) in 2017 and 2018. APMs are intended to improve care and offer participating providers the opportunity to earn an incentive payment under the Quality Payment Program created through MACRA.  The release of the list provides more certainty to clinicians weighing their options for 2017 and beyond.

By way of brief background, the Quality Payment Program rewards clinicians with sufficient participation in Advanced APMs. By giving more clinicians the opportunity to participate in these models that align incentives for the provision of high-quality, patient-centered care, CMS aims to extend the benefits of high-quality, coordinated care to more Medicare beneficiaries.  The CMS Innovation Center (CMMI) tests these innovative care models across the country in an effort to develop sustainable models for the future of healthcare reimbursement.


CMS Finalizes New Medicare Quality Payment Program: “Flexibility” and “Pick Your Pace” Key Themes

Practice area:

After receiving roughly 4,000 comments to its proposed rule, the Centers for Medicare and Medicaid Services (CMS) on October 14, 2016 released its final rule for implementing the Medicare Access and CHIP Reauthorization Act (MACRA). MACRA replaced the sustainable growth-rate formula for physician reimbursement with a new methodology to transition providers from volume to value-based reimbursement. This new approach to payment – called the Quality Payment Program – is a major departure from traditional fee-for-service reimbursement in that it rewards the delivery of high-quality care through Advanced Alternative Payment Models (Advanced APMs) and the Merit-based Incentive Payment System (MIPS) for “eligible clinicians” and groups.

MIPS will consolidate 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 (EPs), and will continue to focus on quality, cost, and use of certified EHR technology (CEHRT) in a cohesive program that avoids redundancies. The proposed rule generated a multitude of comments and