What Is an “Advanced” APM?

For your convenience: APMs = Alternative Payment Models MIPS = Merit-based Incentive Payment System QPs = Qualifying APM Participants CEHRT = Certified Electronic Health Record Technology   The MACRA rule has introduced a load of new acronyms (see above), but here is another wrinkle. What exactly is an “Advanced” Alternative Payment Model? Luckily, several attorneys […]

CMS Releases Final Rule on Controversial New Payment Program for Physicians

For your convenience: MACRA = Medicare Access and CHIP Reauthorization Act QPP = Quality Payment Program APMs = Alternative Models MIPS = Merit-based Incentive Payment System     CMS has issued the much-anticipated final rule to implement the controversial Medicare Access and CHIP Reauthorization Act of 2015. MACRA replaced the sustainable growth rate formula for […]

Nontraditional Partnerships and Credit Ratings, Part 2

Nontraditional partnerships explicitly form to manage accountable care organizations and clinically integrated networks. Shared governance is typical in these types of partnerships. Other nontraditional partnerships include insurance companies, retailers and pharmacy companies.   Accountable care organizations and clinically integrated networks both collaborate among hospitals and physicians to manage large groups of patients to reduce the […]

Comments to CMS: MACRA Threatens Viability of Smaller ACOs

  Smaller accountable care organization (ACO) officials wrote comments to CMS noting that some provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) could hurt the viability of smaller ACOs.   The proposed rule, MACRA, will split physicians into those paid under the Merit-based Incentive Payment System (MIPS) and those paid annual […]

Final Rule Allows ACOs to Use Regional Benchmarks

CMS issued a final rule last week that will allow accountable care organizations (ACOs) to benchmark their results to regional Medicare spending, using a phased approach to incorporating regional fee-for-service (FFS) expenditures into calculations for resetting, adjusting, and updating an ACO’s rebased historical benchmark after an initial three-year agreement period.   National benchmarks will continue […]

More PCPs Can Participate in CPC+

CMS will allow primary care practices in the Medicare Shared Savings Program (MSSP) to participate in the Comprehensive Primary Care Plus (CPC+) initiative. The announcement came in response to stakeholder concerns that a new Medicare primary care payment model could steer physicians away from accountable care organizations.   Up to 1,500 eligible primary care practices […]