According to a Medicare executive, ninety-nine percent of the 100,000 physicians who applied for the advanced alternative payment model (APM) bonus in the first available year qualified for it, according to a Medicare executive. Gregory Woods, the acting deputy director for the Center for Medicare and Medicaid Innovation (CMMI), gave these remarks at the National ACO, Bundled Payment, and MACRA Summit on June 8.
APM Results
As was reported, the results likely reflected the low thresholds required for physicians to receive a bonus. Woods said smaller shares of applying clinicians will qualify for the bonus in upcoming years as requirements tighten. Among the scheduled changes are increases in the qualifying threshold from 25 percent of payment or 20 percent of patients in such models for 2017 to 50 percent of payment or 35 percent of patients in 2019.
About half of the qualifying physicians were working in Track 2 or Track 3 accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP). About 40 percent were in Next Generation ACOs, and the remaining 10 percent were participating in either Comprehensive Primary Care Plus (CPC+), the Comprehensive ESRD model, or the Comprehensive Care for Joint Replacement model.
The 100,000 seeking APM bonus payments represented a “smaller share” of clinicians who participated in any APM because most clinicians were not in models that qualified as advanced APMs under MACRA. Woods said those non-qualifying clinicians were mostly in MSSP Track 1 ACOs, which comprise 82 percent of all Medicare ACOs, according to CMS data. Such physicians will default to the second MACRA track—the Merit-based Incentive Payment System (MIPS), which includes bonuses and penalties that eventually will be as high as 9 percent of a practice’s Medicare payment.
U.S. House Hearing
In a hearing before the U.S. House of Representatives’ Energy and Commerce committee’s health subcommittee, physicians claimed that the CMS has let too many doctors sit out of reporting to the Merit-based Incentive Payment System (MIPS) and that the agency has yet to adopt any alternative pay models recommended by the Physician-Focused Payment Model Technical Advisory Committee (PTAC).
Several lawmakers expressed concern that MACRA wouldn’t be able to meet its promised goals. Rep. Buddy Carter (R-Ga.) said that the GOP Doctor’s Caucus sent a letter to the CMS earlier this month regarding the opt-outs.
“We just don’t have enough physicians who are participating,” Carter said.
Dr. David Barbe, former president of the American Medical Association, expressed dismay at the hearing that the CMS has yet to adopt any of the 10 models recommended by PTAC. MACRA created the advisory group to evaluate and recommend advanced alternative pay models created by providers for the agency.
“Unfortunately, CMS has not seen fit to adopt any of those yet and I think it is thwarting the creativity and innovation that physicians are willing to bring to the table,” Barbe said.
Both Health Subcommittee Chairman Michael Burgess (R-Texas) and ranking member Rep. Gene Green (D-Texas) said they supported holding a hearing where HHS can explain why it isn’t embracing PTAC’s ideas.
“We need to see if our subcommittee can encourage HHS and CMS to give feedback and coordinate with you on where we’re going with this,” Green said.