CMS Advanced Payment Model Physician Participation Doubling 2017-2018
The number of doctors participating in advanced payment models (APMs) nearly doubled in 2018 to 183,306 compared to 99,076 doctors participating in 2017, according to new data. Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma attributed the increase to more opportunities to participate in such models last year, especially via affordable care organizations (ACOs). Additionally, CMS is proposing new rules governing APMs in its Quality Payment Program for 2020.
CMS Data
As CMS Administrator Seema Verma stated in the agency’s news release, the number of qualifying APM participants in Advanced APMs nearly doubled in 2018 from the previous year. These qualifying participants receive a five percent APM incentive payment in their Medicare rates and are excluded from having to participate in the MIPS reporting requirements and payment adjustment.
Additionally, the number of clinicians participating in MIPS through an APM—meaning the APM did not qualify for Advanced APM status—also increased from 341,220 participants in 2017 to 356,828 in 2018. CMS suggests these participation improvements may be related to the increasing number of participation opportunities in 2018, particularly through ACOs in the Shared Savings Program.
“I am excited about this progress, as it is a critical indicator we are succeeding in our goal of maximizing participation in MIPS APMs and Advanced APMs,” Verma said. “This increase in APM participation supports the evolution of the program and incentives towards a system of value that puts patients first.”
New APM Proposed Rules
In its 2020 Proposed Medicare Fee Schedule, CMS did suggest some changes to the APM pathway of the Quality Payment Program (QPP). CMS is proposing certain changes to the way “Other Payer APMs” must be structured in order for physicians participating in a mix of Medicare APMs and Other Payer APMs to be eligible for the five percent incentive payments for qualified APM participants.
02These proposals include establishing a new definition of Aligned Other Payer Medical Home models, consistent with the existing financial risk requirements for Medicaid medical homes, and modifying the marginal financial risk requirements for Other Payer APMs. The proposed rule also includes an estimate that between 175,000 and 225,000 clinicians will achieve qualifying participant status during the 2020 APM participation period.