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CMS Wants More Providers to Participate in Advanced APMs

CMS will reopen applications for new practices and payers in the Comprehensive Primary Care Plus (CPC+) model and for new participants in the Next Generation Accountable Care Organization (ACO) model for the 2018 performance year. Clinicians in the Oncology Care Model (OCM) with two-sided risk in 2017 will qualify as participants in an advanced alternative payment model (APM) under MACRA. MACRA allows clinicians to earn a 5 percent incentive payment if they sufficiently participate in an advanced APM. (“CMS Moves to Expand APM Enrollment, HFMA Weekly, October 28, 2016)


CMS recently made changes to MACRA, allowing clinicians to earn the APM bonus, while avoiding quality-reporting requirements otherwise required by MACRA’s Quality Improvement Program (QIP), if they join certain models for 2017. An abbreviated list appears below:


  • CPC+
  • Medicare Shared Savings Program (MSSP) Track 2
  • MSSP Track 3
  • Next Generation ACO Model
  • OCM with two-sided risk


Qualifying APMs will expand by 2018 to include these models:


  • MSSP 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)


The lists of qualifying APMs are expected to continue to grow. According to DHHS Secretary Sylvia Mathews Burwell, clinicians will have a total of 10 models from the CMS Innovation Center to choose from as they transition from the QIP to APM track.


Announcing the APM expansion, Burwell noted the healthcare industry has “reached her goal of tying 30 percent of payments to APMs by the end of 2016.” HHS is now working toward shifting at least 50 percent of payments into APMs by the end of 2018.

She also said that beginning in 2019, MACRA will give providers credit for participating in Medicaid and commercial APMs. (“CMS Moves to Expand APM Enrollment, HFMA Weekly, October 28, 2016)



To read the CMS release, click here:



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