Advanced Alternative Payment Models Part II: Understanding the Next Generation Accountable Care Organization Model.

Richard Hayden Self, Janis Coffin
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Abstract

With CMS establishing preliminary definitions for fully qualifying Advanced Alternative Payment Models (APMs) in May of 2016, it has become crucial to many care providers accepting Medicare and Medicaid payments to understand the nature of these entities if they wish to eventually participate in one of the current or future payment models. Changes under the Medicare Access and CHIP Reauthorization Act of 2015 specifically identify subsets of APMs that allow providers to avoid possible negative adjustments for poor relative performance compared with their respective peer groups through the Merit-Based Incentive Payment System beginning in 2017. This article reviews the nature of one of the fully qualifying Advanced APMs, the Next Generation Accountable Care Organization (ACO) Model, and its risk-benefit sharing principles based on prior experience with the Medicare Shared Savings Program and other previous ACO models. This model represents a more sophisticated option for organizations with significant ACO experience seeking an Advanced APM for the 2018 reporting reriod and beyond.

先进的替代支付模式第二部分:理解下一代负责任的医疗组织模式。
随着CMS在2016年5月建立了完全合格的高级替代支付模式(APMs)的初步定义,对于许多接受医疗保险和医疗补助支付的医疗服务提供者来说,如果他们希望最终参与当前或未来的支付模式之一,了解这些实体的性质就变得至关重要。2015年《医疗保险准入和CHIP再授权法案》的变化特别确定了apm的子集,这些子集允许供应商通过2017年开始的基于绩效的激励支付系统,避免因相对于各自同行群体的相对表现不佳而可能出现的负面调整。本文回顾了完全合格的先进apm之一,下一代问责医疗组织(ACO)模型的性质,以及基于医疗保险共享储蓄计划和其他以前的ACO模型的经验的风险-收益分担原则。对于在2018年报告期内及以后寻求高级APM的具有丰富ACO经验的组织来说,该模型代表了一个更复杂的选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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