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Medicare Advisory Committee

The HCPLAN is no longer the sole group working to develop APMs. There is also the Medicare advisory committee, which allotted a share of its meeting time last month for the discussion of Alternative Payment Models (APMs), which serve as alternatives to traditional fee-for-service Medicare.

As the previous article mentioned, MACRA supports the development of new APMs, but the legwork is being pushed in the direction of the Centers for Medicare and Medicaid Services. Proposed rules to come out this year will give greater insight into the criteria that new APMs will need to meet. Meanwhile, stakeholders will continue to do their best to speculate and plan ahead.

MedPAC is the independent congressional agency set up to advice congress on issues, which have a bearing on the Medicare program, and is responsible for the formal recommendations that take the form of two reports on Medicare policy matters. Comments are also submitted to agencies on regulatory matters, and while the commission’s recommendations are not law in any way, MedPAC must comment on the different stages of the APM rulemaking. This is the reason for the dedicated session at the January meeting, in order to run discussions on new payment models.

The focus of the meeting was the 5% bonus payment updates, which providers in APMs will be eligible for from 2019-2024. For 2019, providers are supposed to receive at least a quarter of their Medicare payments from an approved or “qualified” APM in 2018. Providers who meet this APM threshold can also forego MIPS participation.

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Alternative Payment Models

The approval criteria will be a component of the upcoming rulemaking, although the commissioners were eager to raise the matter of connecting bonus payments to providers, with being able to prove they can effectively control costs. What remains is to define the “significant” amount of financial risk they will be required to shoulder for this.

Also outlined were draft principles APM entities will hopefully choose to build on. These include incentive payments being linked to cost control and quality, like the ACOs. The commission also wishes APM entities will take on a sufficient number of beneficiaries and take on risk for total Medicare Part A and Part B spending for their beneficiaries. Although only the entity would assume risk, they can share savings with beneficiaries, such as by rewarding them for following treatment plans. The meeting also involved discussions into the nuances of APM functioning.

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