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Renae Rossow
Renae Rossow
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Understanding MACRA and the Quality Payment Program Part 8

Understanding MACRA and the Quality Payment Program Part 8

Part 7 of the Understanding MACRA series provided you with a high overview of the APMs payment track. This week we’re going to look at the different advanced alternative payment models (APMs) and explain them in more detail. 

The following is a list of Advanced APMs for 2017 and an explanation of that APM so that you can consider which, if any, might be worth working towards joining. One thing to note is that CMS is actively trying to grow this list each year to continue making it more easy for small and rural practices to participate in APMs and achieve incentives. 

  1.  Comprehensive End-Stage Renal Disease (ESRD) Care Model
    The Comprehensive ESRD Care (CEC) Model is designed to identify, test and evaluate new ways to improve care for Medicare beneficiaries with End-Stage Renal Disease (ESRD). Through the CEC Model, CMS will partner with health care providers and suppliers to test the effectiveness of a new payment and service delivery model in providing beneficiaries with person-centered, high-quality care. The Model builds on Accountable Care Organization experience from the Pioneer ACO Model Next Generation ACO Model, and the Medicare Shared Savings Program to test Accountable Care Organization for ESRD beneficiaries. There are 37 ESRD Seamless Care Organizations (ESCOs) participating in the Comprehensive ESRD Care Model. You can find that list here:  See ESCOs List.

  2.  Comprehensive Primary Care Plus
    Comprehensive Primary Care Plus (CPC+) is a national advanced primary care medical home model that aims to strengthen primary care through regionally-based multi-payer payment reform and care delivery transformation. CPC+ includes two primary care practice tracks with incrementally advanced care delivery requirements and payment options to meet the diverse needs of primary care practices in the United States. There are 2,993 primary care practices participating in Comprehensive Primary Care Plus. You can see that list here: See CPC+ List.

  3. Next Generation ACO Model
    Building upon experience from the Pioneer ACO Model and the Medicare Shared Savings Program, the Next Generation ACO Model offers a new opportunity in accountable care – one that sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care. There are 45 ACOs participating in the Next Generation ACO Model. You can see that list here:  See ACO List.

  4. The Medicare Shared Savings Program Track 2 and Track 3
    The Medicare Shared Savings Program (Shared Savings Program) was established by section 3022 of the Affordable Care Act. The Shared Savings Program is a key component of the Medicare delivery system reform initiatives included in the Affordable Care Act and is a new approach to the delivery of health care. Congress created the Shared Savings Program to facilitate coordination and cooperation among providers to improve the quality of care for Medicare Fee-For-Services (FFS) beneficiaries and reduce unnecessary costs. Eligible providers, hospitals, and suppliers may participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (ACO). You can see all shared savings program ACOs here:  See Shared Savings ACOs.

  5. Oncology Care Model
    The Center for Medicare & Medicaid Innovation (CMS Innovation Center) is developing new payment and delivery models designed to improve the effectiveness and efficiency of specialty care. Among those specialty models, is the Oncology Care Model, which aims to provide higher quality, more highly coordinated oncology care at the same or lower cost to Medicare. Under the Oncology Care Model (OCM), physician practices have entered into payment arrangements that include financial and performance accountability for episodes of car surrounding chemotherapy administration to cancer patients.  The Centers for Medicare and Medicaid Services (CMS) is also partnering with commercial payers in the model. The practices participating in OCM have committed to providing enhanced services to Medicare Beneficiaries such as care coordination, navigation, and national treatment guidelines for care. There are 190 practices and 6 payers participating in the Oncology Care Model. You can see the list of practices and payers here: See Oncology Care Model List.

  6. Comprehensive Care for Joint Replacement Model
    The Comprehensive Care for Joint Replacement (CJR) model aims to support better and more efficient care for beneficiaries undergoing the most common inpatient surgeries for Medicare beneficiaries: hip and knee replacements (also called lower extremity joint replacements or LEJR). This model tests bundled payment and quality measurement for an episode of care associated with hip and knee replacements to encourage hospitals, physicians, and post-acute care providers to work together to improve the quality and coordination of care from the initial hospitalization through recovery.

  7.  Vermont Medicare ACO Initiative (as part of the Vermont All-Payer ACO Model)
    The Vermont All-Payer Accountable Care Organization (ACO) Model is the Centers for Medicare & Medicaid Services’ (CMS) new test of an alternative payment model in which the most significant payers throughout the entire state – Medicare, Medicaid, and commercial health care payers – incentivize health care value and quality, with a focus on health outcomes, under the same payment structure for the majority of providers throughout the state’s care delivery system and transform health care for the entire state and its population.

 Hopefully, you now have a better understanding of the Advanced APMs that are available to you. As mentioned in the beginning of this article, CMS will be working hard to grow the list of APMs to make it easier for small and rural practices to participate. Stay tuned for next week’s article where we will discuss the differences in reporting as an individual or a group.  



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