CMS to Test Offering Medicare Advantage as Another Track Under QPP

According to Modern Healthcare, CMS wants to lunch “an experiment that allows doctors in Medicare Advantage plans to qualify as participating in an alternative payment model (APM).

For a brief reminder of the Quality Payment Program, clinicians have two tracks to choose from: MIPS, which requires clinicians to report and meet quality goals and APM, which require clinicians to take on financial risk as part of their efforts to improve care and lower costs. They clinicians meet the goals under an APM, they are eligible for bonuses.

Clinicians in Medicare Advantage plans have urged CMS to consider those plans as APMs since some are offering risk-based contracts. When clinicians participate in an APM, they must receive a certain amount of Medicare fee-for-service revenue, but for some providers who primarily see Medicare Advantage patients, that threshold may be too high.

Previously, CMS would have launched a five-year demonstration year. They would have asked providers about the payment arrangements they had with Medicare Advantage plans and the number of patients covered under those arrangements. That information will determine whether the payment arrangement will meet the risk standards to count as an APM.

However, Seema Verma announced late today that they would offer another choice, Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI). MAQI comes as an option as CMS stated there are not enough alternative payment model (APM) options to avoid MIPS requirements.

MA enrollment is projected to grow to 9% in 2018, which will bring total enrollment to 20.4 million lives. CMS estimated that more than one-thirds of all Medicare enrollees will be in a Medicare Advantage plan in 2018.