Physicians who participate in an advanced alternative payment model (APM) this year will remain eligible for incentive payments – albeit smaller ones – that were initially slated to expire in 2022.
The extension is the result of the Consolidated Appropriations Act of 2023, a $1.7 trillion federal spending package that President Joe Biden signed into law on Dec. 29.
Now, eligible clinicians who participate in an advanced APM under Medicare’s Quality Payment Program (QPP) and who meet certain criteria during the 2023 performance year will receive a 3.5% incentive payment in the 2025 payment year. Although these criteria remain the same as in performance year 2022, the incentive payment has fallen from 5%.
To qualify, participating clinicians must:
- Earn at least 50% of their payment from Medicare Part B; and
- See at least 35% of Medicare patients through an advanced APM entity during the performance year.
There are currently seven advanced APM options available in Texas:
- ACO Reach;
- The Medicare Shared Savings Program;
- The Bundled Payments for Care Improvement Advanced Model;
- The Comprehensive Care for Joint Replacement Model;
- The End-Stage Renal Disease Treatment Choices Model;
- The Enhancing Oncology Model; and
- The Kidney Care Choices Model.
Qualifying APM participants are exempt from the Merit-Based Incentive Payment System, the other pathway available under the QPP.
The Consolidated Appropriations Act has other positive implications for Medicare and Medicaid coverage, including:
- Updating the 2023 conversion factor, reducing a scheduled Medicare physician pay cut from 4.5% to 2%;
- Extending pandemic-era telehealth waivers;
- Making permanent an option for states to provide 12 months of continuous Medicaid coverage to children and postpartum women;
- Authorizing 200 additional graduate medical education residency positions, half of which will be dedicated to psychiatry;
- Incentivizing domestic drug manufacturers to address supply shortages; and
- Funding more mental health, maternal health, and substance use disorder services.
Last Updated On
March 02, 2023
Originally Published On
March 01, 2023
Emma Freer
Associate Editor
(512) 370-1383