MACRA proposed rule: What it means for Medicare Advantage

Medicare’s newly proposed physician payment overhaul includes clues that federal health officials want to credit participation in Medicare Advantage plans toward alternative payment models. It establishes a Quality Payment Program for doctors that offers two distinct paths–the Merit-based Incentive Payment System and Advanced Alternative Payment Models (APMs). As it currently stands, though, the Quality Payment Program is based on payments for Medicare Part B, not Medicare Advantage. “The Quality Payment Program has the potential to influence a wide range of payment arrangements, such as those under Medicare Advantage, but there is a clear distinction between Medicare Part B and all other payers in how calculations are performed for QP determinations and the APM Incentive Payment,” the proposed rule states. Under the All-Payer Combination Option, eligible clinicians and “Advanced APM entities” can meet the Quality Payment Program threshold based in part on payment amounts or patient counts associated with Medicare Advantage plans and other payers, according to the proposal. Medicare may base pay on those calculations beginning in 2021. CMS notes that not all Medicare Advantage arrangements count as alternative payment models, as MA plans do not disclose how they pay providers.