CMS expands opportunities for 5% APM bonus in 2018

Practices and payers which want a chance to earn the 5 percent incentive payment offered under CMS’s Advanced Alternative Payment Models (APMs) will have a chance to apply for two qualifying models for 2018.

CMS announced it will open up applications in January and February 2017 for new participants in the Next Generation ACO and Comprehensive Primary Care Plus (CPC+) models. Practices and payers with “sufficient participation” in those models beginning in 2017 will be able to receive the incentive and this fulfills the agency’s October promise to offer new applicants a chance to qualify in 2018.

“We are excited to build on the progress of comprehensive primary care, the foundation of a better health system,” said Patrick Conway, MD acting deputy administrator and CMO at CMS. “Our Next Generation ACO model is the future of accountable care where providers take on full accountability for total cost of care and quality for a population of patients. These models allow doctors and other clinicians to practice the way they want to, including spending more time with patients, and provide coordinated, patient-centered care to all beneficiaries.”

In 2017, clinicians can earn the bonus by participating in one of the following models:

  • 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)

Besides the new Next Generation ACO and CPC+ participants, the following models would also qualify for the bonus beginning in 2018:

  • 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)

CMS predicts 25 percent of clinicians in the Quality Payment Program set up by Medicare Access and CHIP Reauthorization Act (MACRA) will be a part of advanced APMs by the 2018 performance period.