To benefit of physicians, CMS to test Medicare Advantage as an advanced APM

Doctor examining patient
CMS is moving forward with a demonstration that would allow Medicare Advantage contracts with physicians to qualify as advanced alternative payment models under MACRA. (Getty/kazoka30)

Under a demonstration project, CMS will move ahead with plans to test whether certain Medicare Advantage plans should qualify as an advanced alternative payment model and exempt doctors from MIPS.

CMS plans to move ahead with the demonstration, which would waive Merit-Based Incentive Payment System (MIPS) requirements for clinicians in certain at-risk Medicare Advantage plans, the agency said in an announcement.

The Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) demonstration, when approved and adopted, would waive MIPS requirements for clinicians who participate sufficiently in certain Medicare Advantage plans that involve taking on risk. CMS is seeking public comment on the information collection burdens associated with the demonstration, which is under consideration for formal approval.

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The demonstration aligns with the agency’s goal of moving to a value-based healthcare system and would put Medicare Advantage on a more equal playing field with fee-for-service Medicare programs, said CMS Administrator Seema Verma. “CMS intends to test whether MIPS exemptions provided to clinicians under MAQI will increase participation in Medicare Advantage plans that are similar to Advanced APMs, and thereby accelerate the transition to a healthcare system that pays for value and outcomes,” she said.

The model will allow doctors in some Medicare Advantage plans to be considered part of alternative payment models under the Medicare Access and CHIP Reauthorization Act (MACRA). Under MACRA, clinicians have two tracks for payment: MIPS, which requires them to report quality data to CMS and have their payment adjusted accordingly; and Advanced Alternative Payment Models (APMs), which require clinicians to take on risk for their patients’ healthcare spending.

Some Medicare Advantage plans now include innovative arrangements that resemble advanced APMs. But without this demonstration program, physicians are still subject to MIPS reporting even if they participate extensively in these arrangements under Medicare Advantage, CMS said. If doctors meet goals under an APM, they are eligible for bonus payments.

In a final rule released last November on the Quality Payment Program, CMS said it intended to develop a demonstration project to test the effects of allowing clinicians to receive credit for financial risk-based arrangements with Medicare Advantage plans “prior to 2019 and through 2024.”

RELATED: CMS unveils final MACRA implementation rule: 10 changes to the Quality Payment Program

Under a previously issued final rule, CMS said it would not allow Medicare Advantage plans to qualify as advanced APMs until the 2021 payment adjustment year. Provider groups and insurers were not happy with CMS’ original determination that MACRA would include traditional Medicare but not Medicare Advantage.

One group that welcomed the MAQI demonstration was America’s Physician Groups, a professional association for accountable physician groups, which said it creates an important new path for groups wanting to move into value payments.

“Our members know well the increasing importance of Medicare Advantage (MA), and we’re fighting hard to modernize this program that is so critical to the health of millions of America’s seniors,” said Donald H. Crane, the group’s president and CEO, in an announcement. “Through our meetings with CMS and CMMI leadership, coalition-building, and grassroots advocacy, we are proud to have succeeded in pushing through the first Medicare demonstration project under the current administration.”

“With nearly 19 million beneficiaries enrolled in Medicare Advantage, it is important to recognize the innovations that physician organizations are undertaking to provide high-quality accountable care to the patients and communities they serve. Advancing the MAQI Demonstration is an important step in the right direction,” Crane said.

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