BOSTON—There’s a big problem with advanced alternative payment models (APMs). There aren’t enough of them.
Opportunities for doctors and physician practices to participate in advanced APMs remain stifled, according to the Medical Group Management Association's (MGMA) government affairs staff.
Only one new advanced APM has been approved so far under the Trump administration, Mollie Gelburd, J.D., an associate director of government affairs, told participants at MGMA’s annual conference in Boston this week.
“We are about two full years into the program, and we find we are in the same place,” she said about advanced APMs, one of two tracks under the Medicare physician payment system implemented by the Medicare Access and CHIP Reauthorization Act (MACRA).
The frustration is being felt by MGMA members. In an MGMA survey conducted over the last month of 426 individuals from group practices, 55% said Medicare does not offer an advanced APM that is clinically relevant to their practice. Only 11% said an advanced APM is available to them.
Yet 44% said their practice would be interested in participating in an advanced APM if it was clinically relevant and aligned with the medical group’s quality goals.
The interest exceeds the opportunity to move to an APM, said Anders Gilberg, senior vice president of government affairs for the MGMA. “We’re definitely stuck in a rut,” he said.
MIPS, the other track under MACRA, is often seen as an “on ramp” to move physicians to advanced APMs, where they can earn a 5% incentive payment.
So how do new advanced APMs get approved? One route is the Center for Medicare & Medicaid Innovation (CMMI), which was established under the Affordable Care Act to test new payment models. The Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services are promising to develop new models, Gelburd said.
The other route is the Physician-focused Payment Model Technical Advisory Committee (PTAC), which was created by the MACRA legislation to make comments and recommendations to the secretary of HHS on proposals for physician-focused payments models submitted by physicians and physician groups. That’s a bottom-up approach, Gelburd said, in which physicians submit proposals for APMs.
The PTAC makes recommendations to HHS to implement or test these proposed payment models.
So far, CMS has been slow in pushing out CMMI models, Gelburd said. And HHS has yet to implement any of the options recommended by the PTAC, resulting in growing frustration. There was also little discussion of advanced APMs in the new proposed rule to establish a physician fee schedule for 2019 and set the rules for year three of MACRA, she said.
The Bundled Payments for Care Improvement (BPCI) Advanced model was the first advanced payment model launched by CMS under the Trump administration last January.
Are more advanced APMs on the way? MGMA government affairs staff said that remains to be seen. “CMS isn’t speaking loudly,” said Gelburd.
One bit of good news: Under a demonstration project, CMS will move ahead with plans to test whether certain Medicare Advantage plans should qualify as an advanced APM and exempt doctors from MIPS. CMS announced over the summer that it plans to move ahead with the demonstration, which would waive MIPS requirements for clinicians in certain at-risk Medicare Advantage plans.