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    7 things physicians need to know about MACRA proposed rule

     

    6. The APM route

    CMS anticipates more providers will qualify for the APM route after the first year and move in this direction.

    In 2019 through 2024, physicians participating in APMs would receive a lump sum payment of 5% of their prior year Medicare Part B payment.

    Broadly speaking, APMs are payment models such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs). The MACRA rule says APMs must meet three requirements to qualify:

    • participants must use certified EHR technology;
    • the APM must pay clinicians based on quality measures comparable to those used in the quality performance category of MIPS; and
    • be either an accredited PCMH or participate in risk-sharing as part of an ACO-like arrangement or, as the rule puts it, “bear more than a nominal amount of risk for monetary loses.”

    The proposed list of models that would qualify for primary care physicians include: the new Comprehensive Primary Care Plus program, Medicare Shared Savings Program, or next generation ACOs. CMS says it will update the list of qualified APMs annually.

    Next: Does this change meaningful use right now?

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    • Anonymous
      It will likely take 1 high salaried or 2 low salaried employees to do the required documentation for this nonsense. Another nail in the coffin for private practice. However, even very large group practices will struggle to meet these requirements.
    • Anonymous
      It will likely take 1 high salaried or 2 low salaried employees to do the required documentation for this nonsense. Another nail in the coffin for private practice. However, even very large group practices will struggle to meet these requirements.

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