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Change in CMS primary-care program seen scaring away some providers


CMS widens options for APMs

CMS  offering additional opportunities for physicians and other clinicians to join advanced Alternative Payment Models beginning in 2017 and 2018.

The advanced Alternative Payment Model is the more lucrative of two options under the Medicare Access and CHIP Reauthorization Act, (MACRA) a payment system for Medicare physician fees that replaces the controversial Sustainable Growth Rate formula.

CMS will offer the Oncology Care Model with two-sided risk as a qualifying advanced APM beginning in 2017 and  will reopen applications for the Comprehensive Primary Care Plus model and the Next Generation ACO model for the 2018 performance year.

Patrick Conway, M.D., deputy CMS Administrator,  said:

“With these new opportunities, CMS expects that by the 2018 performance period, 25 percent of clinicians in the Quality Payment Program will earn incentive payments by being a part of these advanced models. Thanks to MACRA and the Innovation Center, we’re striving to see more Medicare patients benefit from better care when they visit their doctor for a knee replacement, receive cancer treatment or have a coordinated care team manage their complex conditions.”

Physicians who participate in Medicare must submit at least some performance data next year to avoid a penalty under MACRA. These data will determine payment adjustments beginning in 2019. Physicians who qualify as an advanced APM will avoid some reporting requirements and be eligible for a 5 percent lump-sum bonus.

To read a Becker’s Hospital Review article on this, please hit this link.


How Minn. saves a pile with ‘healthcare homes’

 

Governing magazine looks at how  the Feds’ new Comprehensive Primary Care Plus program will affect how 20,000 doctors serve 25 million patients. The five-year program, which will be launched next January, will pay participating providers a fixed monthly fee, along with bonuses for meeting various health goals. Traditionally, those providers have been reimbursed based on the number of patient visits or procedures. “That approach has long been lambasted by healthcare experts as a big reason for rising costs,” the magazine noted.

The new move could encourage states to adopt the “healthcare home” model that’s been shown not only to improve health outcomes but also to save billions of dollars. Despite the potential,  states have not widely embraced it.

Governing looks at one state that has embraced it — Minnesota.

“The Land of 10,000 Lakes”  has become a model for healthcare homes,  a program that has saved it more than $1 billion over the past five years, said  a study by the University of Minnesota earlier this year. “These healthcare homes embody precisely what advocates of a coordinated healthcare system want: a one-stop shop for a patient to get all of her health needs met in as few visits as possible.”

One state that has become a model for health-care homes is Minnesota, which has saved more than $1 billion over the past five years by investing in that form of care, according to a study by the University of Minnesota earlier this year. These health-care homes embody precisely what advocates of a coordinated health-care system want: a one-stop shop for a patient to get all of her health needs met in as few visits as possible.


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