CMS Finalizes Alternative Payment Models in MACRA

MACRA Alternative Payment Models Finalized by CMS

Making them easier to enroll in and utilize

In an earlier blog post, we gave you information about the impending changes due to be enacted as a result of MACRA, the Medicare Access and CHIP Reauthorization Act of 2015.  Just recently some of those changes became clear as the centers for Medicare and Medicaid Services published more information on the programs created for the reimbursement of hospitals, physicians and other health care providers.

Just before the close of 2016, CMS published a rule that simplifies the criteria for physicians to meet the standards for the Advanced Payment Models or APMs created by MACRA.  Known as the Advancing Care Coordination through Episode Payment Models rule, it’s aim is to inspire hospitals, physicians and other care providers to work together to provide better care at lower costs, through rewards and reimbursements in these alternative payment models.  

Though some in Washington, such as Tom Price, the new Secretary of the Health and Human Services department have expressed opposition toward implementing these new alternative payment models without previous testing, CMS plans to implement the two new models in July of this year.  

A total of 98 metro areas (roughly 1/4th of all national metro areas) will implement the cardiac APMs, while 67 metro areas will implement new models for the surgical treatment of hip fractures.  In order to encourage health care providers to enroll in these APMs, the new CMS ruling has reduced the number of items with which these organizations must comply.  In doing so, the new ruling has enabled smaller organizations, such as small private practices to enroll.

According to Healthcare Finance News, CMS plans to offer education and training to help healthcare providers better understand the changes, how to enroll and work within these new models.  In addition to this education, CMS will be making fact sheets available to help physicians and clinicians keep track of the qualification criteria for reimbursement payments.
You can learn more about the changes and information behind them here.