If your practice is in a mandatory bundled payment model, such as the Comprehensive Care of Joint Replacement (CJR), you may qualify to receive incentives as an advanced alternative payment model (APM).
In a proposed rule set for release July 26, CMS proposes to expand its definition of an advanced APM to include CJR as well as two new hospital-based mandatory bundled payment models proposed for cardiac patients under the new quality payment program required by the Medicare Access and CHIP Reauthorization Act (MACRA).
In its original proposed rule for MACRA, released April 27, CMS had excluded CJR participants from advanced APMs because their bundled service program is hospital based. The two new cardiac bundled service programs are also hospital based and would cover care of patients who have a heart attack or receive bypass surgery.
To qualify as advanced APMs, CMS says providers in these models would need to:
- bear risk for monetary losses that meets the proposed nominal risk criteria;
- use quality measures that meet the proposed measure requirements to base payments; and
- use certified electronic health record technology.
In addition, the proposed rule would expand the scope of CJR to include surgical hip/femur fracture treatments and add a new payment model designed to increase use of cardiac rehabilitation.
The reporting period for MACRA is set to begin Jan. 1. CMS proposes to begin phasing in the new cardiac bundled payment programs in July 2017. The programs would be able to qualify as advanced APMs starting in 2018.