The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) made extensive changes in the way Medicare reimburses physicians for their services. Under the Centers for Medicare & Medicaid Services’ (CMS) new Quality Payment Program, medical providers will either take part in the Merit-Based Incentive Payment System (MIPS) or qualify for the Alternative Payment Models (APMs) track. Under the MIPS track, CMS will calculate physician reimbursement increases or decreases by assessing performance in four categories: quality, resource use, advancing care information/meaningful use and clinical practice improvement activities. Under the APM track, physicians providing high quality, cost-efficient medical care have the opportunity to qualify for incentive payments. Here’s what urologists need to know about APMs.
APMs are systems other than the classic fee-for-service system. APMs aim to add value through improved quality and lower cost. MACRA defines APMs as a Center for Medicare & Medicaid Innovation model under section 1115A (other than a Health Care Innovation Award), Medicare Shared Savings Program (MSSP), a demonstration under the Health Care Quality Demonstration Program, or a demonstration required by Federal law.
Advanced APMs are a subcategory of APMs and allow medical providers to earn incentives through assuming some risk in regards to patient outcomes.
From 2019 to 2024 physicians can earn a 5% incentive payment each year using Advanced APMs. Payment will be issued in 2019 for Advanced APM participation in 2017, the first performance year. In order to qualify for Advanced APM incentives, medical providers must receive 25% of Medicare Part B payments through an Advanced APM or see 20% of Medicare patients through an Advanced APM. CMS will publish a final list of qualifying Advanced APMs by January 1, 2017, but the current list contains seven options; 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 and Oncology Care Model (two-sided risk arrangement).
While we anticipate that most urologists will opt for the MIPS option, there are benefits to the APM track. To learn how we can help you navigate the Quality Payment Program, please contact us 540.345.3556.