CMS Expands Advanced APM Choices

CMS Expands Advanced APM Choices

The Centers for Medicare & Medicaid Services (CMS) announced Dec. 20 several new Innovation Center models and an update to the Comprehensive Care for Joint Replacement Model. The new payment models will allow for a broader range of clinicians to qualify for a 5 percent incentive payment through the Advanced Alternative Payment Model (APM) track of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the Quality Payment Program.

The new models focus on:

What is Macra

  • Improving cardiac care: Three new payment models will support clinicians in providing care to patients who receive treatment for heart attacks, heart surgery to bypass blocked coronary arteries, or cardiac rehabilitation following a heart attack or heart surgery. The official names of the new models are:
    • Acute Myocardial Infarction (AMI) Model
    • Coronary Artery Bypass Graft (CABG) Model
    • Cardiac Rehabilitation (CR) Incentive Payment Model
  • Improving orthopedic care: The Surgical Hip and Femur Fracture Treatment (SHFFT) Model will support clinicians in providing care to patients who receive surgery after a hip fracture, other than hip replacement.
  • Providing an Accountable Care Organization (ACO) opportunity for small practices: The new Medicare ACO Track 1+ Model will have more limited downside risk than Tracks 2 and 3 of the Medicare Shared Savings Program.

The first performance period for the new episode payment models (AMI, CABG, CR, and SHFFT Models) will begin on July 1, 2017. Clinicians who participate in these new payment models could potentially earn the 5 percent incentive payment as early as performance year 2018 — the second performance year of the Quality Payment Program.

In addition, CMS is finalizing updates to the Comprehensive Care for Joint Replacement Model, which began in April 2016, allowing it to qualify as an Advanced APM under the Quality Payment Program. Clinicians who participate in this model could potentially earn the Advanced APM incentive payment beginning in the first performance year (2017) of the Quality Payment Program.

For complete details, see the CMS news release.

Renee Dustman

Renee Dustman

Executive Editor at AAPC
Renee Dustman, BS, MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. She has more than 20 years experience in print production and content management, and has worked in a variety of capacities for several publications.
Renee Dustman

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Renee Dustman, BS, MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. She has more than 20 years experience in print production and content management, and has worked in a variety of capacities for several publications.

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