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MACRA Proposed Rule Incentivizes Risk-Based Coordinated Care, Implements Major Physician Payment Reform
[April 29, 2016]

MACRA Proposed Rule Incentivizes Risk-Based Coordinated Care, Implements Major Physician Payment Reform


CAPG President and Chief Executive Officer Donald Crane issued this statement today on the Centers for Medicare & Medicaid Services (CMS) proposed rule that will continue implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The rule includes provisions that will begin to spell out the Merit-Based Incentive Payment System (MIPS) path and the Alternative Payment Model (APM (News - Alert)) path.

"MACRA repealed the flawed sustainable growth rate formula for Medicare Part B payments to physicians. The law, enacted in April 2015, charts a future course for payment intended to accelerate participation in risk-based coordinated care models. For the first time, this rule begins to spell out how that acceleration will be achieved.

"While our analysis continues, CAPG is pleased that the rule is consistent with our recommendations. CMS proposed requiring two-sided financial risk for the advanced APM models (those tat may qualify for a five percent incentive payment and are exempt from MIPS). Specifically, CMS proposed defining these 'Advanced APM' models to include the Next Generation ACO, the two-sided risk tracks in the Medicare Shared Savings Program, the Comprehensive ESRD Care Model (large dialysis organization arrangement), the Comprehensive Primary Care Plus, and the Oncology Care Model Two-Sided Risk Arrangement.



"As we stated to the agency in prior MACRA comments, risk-based APMs have the potential to align incentives for the right care, encourage preventive services and improve treatment for seniors with chronic conditions. We believe MACRA has strong potential to rapidly move the delivery system in this direction.

"CAPG looks forward to carefully reviewing all of the proposals in the rule and working with our members to develop and submit comments to the agency."


About CAPG

CAPG is the nation's leading association for and the voice of physician organizations practicing capitated, coordinated care. Its membership comprises more than 210 multispecialty medical groups and independent practice associations (IPAs) across 40 states, the District of Columbia, and Puerto Rico. CAPG members strongly believe that comprehensive, accountable, risk-based coordinated care provides the highest quality, most efficient delivery, and greatest value for patients. Our members have successfully operated under this budget-responsible model for more than two decades. For more information, please visit www.capg.org.


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