The CMS expects 359,000 clinicians to participate in four alternative payment models this year, the agency said Wednesday, touting those numbers as evidence of success in shifting away from fee-for-service and into value-based care.
Those alternative payment models include accountable care organizations—the Medicare Shared Savings Program, the Next Generation ACO Model and the Comprehensive End-Stage Renal Disease Care Model—and the Comprehensive Primary Care Plus Model.
“By listening to physicians and engaging them as partners, the CMS has been able to develop innovative payment reforms that bring physicians back to the core practice of medicine—caring for the patient,” said CMS Acting Administrator Andy Slavitt, in a statement. The agency's solutions, he added, would improve the quality of services to beneficiaries while lowering costs.
Those 359,000 clinicians would serve more than 12.3 million Medicare and/or Medicaid beneficiaries, the CMS said. By the end of 2018, the agency expects 25% of clinicians in the Quality Payment Program—also known as MACRA, or the Medicare Access and CHIP Reauthorization Act of 2015—to participate in alternative payment models.
The Shared Savings Program, which was created by the Affordable Care Act, added 99 new participants in 2017, bringing its total to 480 participants. The Next Generation ACO model, which falls under the purview of the CMS Innovation Center, more than doubled in 2017, with 28 new participants bringing the total number to 45.
The Comprehensive End-Stage Renal Disease Care Model and the Comprehensive Primary Care Plus Model are also models being tested by the CMS Innovation Center. The future of the CMMI and the pilot programs it creates are in Republicans' crosshairs. Opponents say the center oversteps its authority when it mandates participation in a program. But Democrats and Republicans alike recognize the need to lower costs and improve the quality of healthcare delivery.
The administration has described its efforts in shifting to paying for healthcare on the basis of quality, not quantity, as being better for patients, providers and payers. But the healthcare industry has pushed back at times, saying the CMS and its Innovation Center are moving too quickly for the industry to keep up.
In October, the Federation of American Hospitals voiced concerns about “the pace of change” and the “burden that such rapid and multiple changes in the delivery system and related payment structure place on hospitals and their workforces.” It was commenting on a rule the CMS proposed in July to bundle payments for all care surrounding heart attacks and bypass surgery.
Also in October, the CMS expanded ways for providers to participate in qualified advance alternative payment models under MACRA. At the time, it said that its lists of models “will continue to change and grow as more models are proposed and developed in partnership with the clinician community and the Physician-Focused Payment Model Technical Advisory Committee.”
