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New CMS APMs finalize cardiac, orthopedic bundled payment models

Continuing a streak of growth in MACRA participation opportunities, the Centers for Medicare and Medicaid Services (CMS) finalized late Tuesday additional Advanced Alternative Payment Models (APMs). Those that receive 25% of their payments from Medicare or with 20% of patients who are Medicare beneficiaries can qualify under the Quality Payment Program.

The announcement finalized a number of policies, including the cardiac and orthopedic mandatory bundle payments it had demonstrated earlier this year. Under the new approaches, the hospital in which a Medicare patient is admitted for care for a heart attack, bypass surgery, or a hip or femur procedure will be accountable for the quality and cost of care provided to Medicare fee-for-service beneficiaries during the inpatient stay and for 90 days after discharge. 

These models will begin their five-year operations beginning July 1, 2017. The cardiac models will apply to hospitals located in the 98 metro areas participating in the model while the surgical hip fracture treatment model will apply to hospitals in the same 67 metro areas currently included in the Comprehensive Care for Joint Replacement Model.

In addition, CMS finalized Medicare ACO Track 1+ Model to encourage more practices to participate in performance-based risk. 

When the MACRA implementation rule was released, CMS noted additional APM opportunities would likely be coming down the pike. With the ground on the final rule not even cold yet, the agency announced additional APM opportunities later that month. Tuesday's announcement continues to expand options for providers to participate.

The new models resulted from "heavy input" the agency said it received from members of the country's medical community. For example, comments on the proposed models expressed concern over the financial risk associated with APM participation. To address these concerns, the ACO Track 1+ Model was designed with more limited downside risk than Tracks 2 or 3 of the Medicare Shared Savings Program, which help to allow smaller hospitals, including rural hospitals, to get into the APM game.

"When we introduced the Quality Payment Program, we discussed that this is not a static drop of a rule but rather the beginning of an ongoing operating communication process with the physician community," CMS acting Administrator Andy Slavitt said on a press call Tuesday. With the three new cardiac care models, a model for orthopedic care and the finalized Medicare ACO Track 1+, the agency projects about 200,000 clinicians (an increase of about 70,000) will qualify for APMs in 2018. 

Shortly after Tuesday's announcement, the American Medical Association expressed its support for CMS "as it expands the models that can qualify as advanced APMs, allowing more practices to have the opportunity to succeed under MACRA without participating in MIPS," President Andrew W. Gurman said in a statement. "We hope that CMS will continue to expand the list of advanced APMs in the future so new delivery and payment arrangements can be supported and promoted – a win for physicians and patients alike.”

APM options currently available for 2017 are:

  • Orthopedic Care Model;
  • Comprehensive ESRD Care Model (Large Dialysis Organization (LDO) arrangement);
  • Comprehensive ESRD Care Model (non-LDO two-sided risk arrangement);
  • CPC+;
  • Medicare Shared Savings Program – Track 2;
  • Medicare Shared Savings Program – Track 3;
  • Next Generation ACO Model; and
  • Oncology Care Model (two-sided risk arrangement).

The Physician-Focused Payment Model Technical Advisory Committee (PTAC), established earlier this year by MACRA, began accepting proposals for APMs earlier this month; there is no deadline for submitting proposals. At the National MACRA MIPS/APMS Summit​, the committee outlined the criteria that must be met in order for it to include a proposal in its recommendations to the HHS Secretary.

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Filed Under: Payer Health Law Finance Policy & Regulation
Top image credit: Flickr; Phalinn Ooi