MACRA Proposed Rule Incentivizes Risk-Based Coordinated Care, Implements Major Physician Payment Reform

Statement issued today by CAPG President and Chief Executive Officer Donald Crane on the Centers for Medicare & Medicaid Services (CMS) proposed rule that will continue implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The rule includes provisions that will begin to spell out the Merit-Based Incentive Payment System (MIPS) path and the Alternative Payment Model (APM) path.

“MACRA repealed the flawed sustainable growth rate formula for Medicare Part B payments to physicians. The law, enacted in April 2015, charts a future course for payment intended to accelerate participation in risk-based coordinated care models. This rule begins, for the first time, to spell out how that acceleration will be achieved.

“While CAPG’s analysis of the rule continues, we are pleased that, consistent with our recommendations, CMS has proposed requiring two-sided financial risk in for the advanced APM models (those that may qualify for a five percent incentive payment and are exempt from MIPS). Specifically, CMS has proposed defining these ‘Advanced APM’ models to include the Next Generation ACO, the two-sided risk tracks in the Medicare Shared Savings Program, the Comprehensive ESRD Care Model (large dialysis organization arrangement), the Comprehensive Primary Care Plus, and the Oncology Care Model Two-Sided Risk Arrangement.

“As we stated to the agency in prior MACRA comments, risk-based APMs have the potential to align incentives for the right care, encourage preventive services, and improve treatment for seniors with chronic conditions. We believe that MACRA has the strong potential to rapidly move the delivery system in this direction.

“We look forward carefully reviewing all of the proposals in the rule and to working with CAPG members to develop and submit comments to the agency.”