CMS Provides Additional Resources to Improve Care and Prepare for the Quality Payment Program for Clinicians

By: Patrick Conway, MD, MSc, CMS Acting Principal Deputy Administrator and Chief Medical Officer

Last year, an overwhelmingly bipartisan Congressional majority – with the support of the medical community and stakeholders – passed the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA. The law ended more than a decade of last-minute fixes and 17 potential payment “cliffs” for thousands of Medicare fee-for-service clinicians, while moving away from paying for each service a physician provides towards a system that rewards physicians for coordinating their patient’s care and improving the quality of care delivered.

Over the past year, we have worked in the same spirit as the law’s model of partnership and progress as we implement policies to improve the health and well-being of Americans. Today, the Centers for Medicare & Medicaid Services (CMS) announces up to $10 million over the next three years to fund the second round of the Support and Alignment Networks under the Transforming Clinical Practice Initiative (TCPI).

TCPI currently consists of 39 national and regional health care networks and supporting organizations – Practice Transformation Networks and Support and Alignment Networks – that provide assistance to thousands of clinicians in all 50 states to improve care coordination and quality and to better understand their patients’ needs. These networks are a key support for clinicians preparing for the payment changes under MACRA by helping clinicians transform the way they deliver care and participate in Alternative Payment Models (APMs), a key part of the proposed Quality Payment Program.

Eligible Medicare clinicians in the proposed Quality Payment Program who sufficiently participate in Advanced APMs could receive a 5 percent bonus Medicare payment beginning in 2019 for their participation in the 2017 performance period. Eligible clinicians who participate in the proposed Quality Payment Program through the Merit-based Incentive Payment System (MIPS) could also benefit from participating in APMs. By participating in these models, the eligible clinicians could receive a favorable scoring standard under MIPS, as well as extra credit in the Clinical Practice Improvement Activities performance category. Clinicians who perform well under MIPS in the 2017 performance period may qualify for up to a 4 percent Medicare payment adjustment in 2019, with additional bonuses for the highest performers.

TCPI helps more clinicians to improve quality, coordinate care, and spend dollars more wisely by providing peer-to-peer support to primary and specialty physicians, nurse practitioners, physician assistants, clinical pharmacists, and their practices. For clinicians that elect to participate in MIPS, this support will help them be successful. Participating networks also disseminate best practices and provide technical assistance and coaching to practices that are moving towards participation in APMs.

Today’s announcement continues to support clinicians across the country in transforming their practices by requiring competitive applications to have signed commitments to enroll a minimum 5,000 or more eligible clinicians and their practices in their network. These clinician practices must be advanced in delivering high-quality and efficient care, so that they can quickly learn from the initiative, support improvement at scale, and join APMs.

As a practicing physician, I know the importance of quality improvement support and sharing of best practices to help clinicians transform their practice and deliver outstanding care to every patient.

CMS encourages all qualified entities to apply for the Support and Alignment Network 2.0 funding opportunity so that we can continue to build on the successes we have made so far.

If you are a clinician who is interested in finding a Support and Alignment Network or Practice Transformation Network near your practice, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-09-29.html.

For more information on the Transforming Clinical Practice Initiative, please visit: https://innovation.cms.gov/initiatives/Transforming-Clinical-Practices/.

For a fact sheet on the Support and Alignment Network 2.0 Funding Opportunity Announcement, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-06-10.html.

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