{"id":20422,"date":"2018-08-08T10:36:55","date_gmt":"2018-08-08T14:36:55","guid":{"rendered":"http:\/\/www.carecloud.com\/continuum\/?p=20422"},"modified":"2025-10-24T14:39:22","modified_gmt":"2025-10-24T14:39:22","slug":"alternative-payment-models-overview","status":"publish","type":"post","link":"https:\/\/carecloud.com\/continuum\/alternative-payment-models-overview\/","title":{"rendered":"2018 Alternative Payment Models (APMs) Overview"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">The Medicare Access and CHIP Reauthorization Act of 2015 <\/span><a href=\"https:\/\/www.carecloud.com\/continuum\/macra-whats-changing-whats-new-for-2018\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">(MACRA)<\/span><\/a><span style=\"font-weight: 400;\"> was updated by CMS to continue to move healthcare providers from fee-for-service payment, or volume-based, to value-based patient care. As a part of the reform, Quality Payment Program (QPP) policy reforms Medicare Part B payments for clinicians across the country, and is a major step in improving care across the entire health care delivery system. Clinicians can choose how they want to participate in QPP based on their practice size, specialty, location, or patient population. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">The Alternative Payment Model (APM) and the Merit-Based Incentive Payment System (MIPS) are the two reimbursement paths used in the Quality Payment Program (QPP).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">These two paths consolidate existing quality reporting programs to reduce data measuring redundancies that support the provision of quality value-based care. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">The Alternative Payment Model (APM) is a form of payment reform that incorporates quality and total cost of care into healthcare reimbursement. Additional compensation is provided as an incentive for high-quality, cost-effective, coordinated care with a focus on better patient outcomes. <\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Alternative Payment Models (APM)<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">An Alternative Payment Model (APM) is a payment approach with <\/span><a href=\"https:\/\/www.carecloud.com\/continuum\/aiming-for-incentives-under-apms\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">added incentives <\/span><\/a><span style=\"font-weight: 400;\">and risks for providing high-quality, cost-effective care. An APM can apply to the care of specific conditions, care episodes, or populations. A risk and reward arrangement is created between providers and payers with the most common being the <a href=\"https:\/\/www.carecloud.com\/continuum\/medicare-shared-savings-program-mssp\/\" target=\"_blank\" rel=\"noopener\">Medicare Shared Savings Program (MSSP)<\/a> or an <a href=\"https:\/\/www.carecloud.com\/continuum\/what-is-an-accountable-care-organization\/\" target=\"_blank\" rel=\"noopener\">Accountable Care Organization (ACO)<\/a>. When a provider joins an APM entity, they can earn financial incentives to provide high-quality and cost-effective care. <\/span><\/p>\n<h3><b>Three Broad Categories of APMs:<\/b><\/h3>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Advanced Alternative Payment Models (AAPM)<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">MIPS Alternative Payment Models (MIPS)<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Other APMs<\/span><\/li>\n<\/ul>\n<h3><b>Examples of APM Models in Medicaid:<\/b><\/h3>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Patient-Centered Medical Homes<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Medicaid Health Home<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Bundled Payments <\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">ACOs<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">To qualify as participating in an APM a physician must receive a certain amount of fee-for-service revenue. This threshold has been too high for many physicians who primarily see Medicare Advantage Patients. Therefore, currently,\u00a0<\/span><a href=\"http:\/\/www.modernhealthcare.com\/article\/20180629\/NEWS\/180629900?utm_source=modernhealthcare&amp;utm_campaign=am&amp;utm_medium=email&amp;utm_content=20180629-NEWS-180629900%E2%80%99\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">CMS is being urged<\/span><\/a><span style=\"font-weight: 400;\"> to consider Medicare Advantage Patients as APM. An APM can be difficult to sustain because providers are generally assessed based on historical benchmarks. Once costs are low, they must remain low or be further reduced for the provider to earn shared savings. <\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Value-Based Reimbursement <\/span><\/h2>\n<p><span style=\"font-weight: 400;\">MIPS requires that physicians meet and report on the specific quality goals. The <\/span>burden for smaller providers <span style=\"font-weight: 400;\">with 15 or fewer eligible physicians was eased in 2018 to allowed them to potentially earn a bonus and encourage success if they report on at least one category. The MACRA Quality Payment Program (QPP) is a value-based reimbursement framework that allows providers to participate in MIPS or APM to receive a positive, neutral or negative Medicare payment adjustment in subsequent years. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Changes in 2018 were consistent in economic risk for physicians if they do not participate or if they perform poorly. Anticipated payment adjustments include: <\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">4 percent payment adjustment for 2019 <\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">5 percent payment adjustment for 2020<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">7 percent payment adjustment for 2021<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">9 percent payment adjustment for 2022 and beyond<\/span><\/li>\n<\/ul>\n<h2><span style=\"font-weight: 400;\">Focus on Quality Care<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Payment adjustment would be based on specified measures and activities within the MIPS four performance categories: <\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><b>Quality: 50 percen<\/b><span style=\"font-weight: 400;\">t &#8211; The reporting measures, which replaced the Physician Quality Reporting System, were reduced from 9 to 6 and allowed for options to accommodate differences in specialties.<\/span><\/li>\n<li style=\"font-weight: 400;\"><b>Cost: 10 percent<\/b><span style=\"font-weight: 400;\"> &#8211; This score is based on Medicare claims and this percentage is expected to increase to 30 percent by 2019.<\/span><\/li>\n<li style=\"font-weight: 400;\"><b>Advancing Care Information: 25 percent<\/b><span style=\"font-weight: 400;\"> &#8211; This replaces the electronic health record (EHR) incentive program known as meaningful use to better reflect how EHR technology is used in daily practice.<\/span><\/li>\n<li style=\"font-weight: 400;\"><b>Clinical Practice Improvement Activities: 15 percent<\/b><span style=\"font-weight: 400;\"> &#8211; This includes care coordination, patient safety, and other options based on the goals of the practice. Credit is received for participating in an APM or Patient-Centered Medical Homes.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Many physicians may have chosen the MIPS reimbursement path to avoid penalties while striving to achieve performance incentives based on quality and value measures. Although if the quality of care is met in relation to cost, with increased risk more opportunities for financial rewards can be achieved with an Advanced APM.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Advanced APMs<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Advanced APMs are a subset of APMs with greater revenue risk and opportunities for financial rewards. Each performance year, The Centers for Medicare &amp; Medicaid Services (CMS) reviews and determines which APMs meet the requirements of an Advanced APM. If specific thresholds are achieved, providers can be excluded from the MIPS reporting requirement and payment adjustment. To qualify for the Advanced APM the provider must meet <\/span><span style=\"font-weight: 400;\">the requirements<\/span><span style=\"font-weight: 400;\"> of the APM and: <\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Use Certified <\/span><a href=\"https:\/\/www.carecloud.com\/ehr\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">EHR<\/span><\/a><span style=\"font-weight: 400;\"> technology<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Receive payment is based on quality measures of MIPS through participation in an APM<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Bear more than nominal financial risk and may be required to refund Medicare if spending exceeds a projected amount<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">In the Advanced APM of the Quality Payment Program (QPP), providers can earn a 5 percent incentive for 2020 for achieving threshold levels of payments or patients through the Advanced APM 2018 Performance Year. They may also earn a higher physician fee schedule starting in 2026.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">MIPS APMs <\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Not all APMs will meet the definition of Advanced APMs and be excluded from MIPS reporting requirements and payment adjustments. APMs that do not qualify as Advanced APM but fall into one of the defined categories may be considered a<\/span><a href=\"https:\/\/qpp.cms.gov\/apms\/overview\"><span style=\"font-weight: 400;\"> MIPS APM<\/span><\/a><span style=\"font-weight: 400;\">. This could be an Advanced APM that a physician participates in but doesn\u2019t meet minimum thresholds for data. MIPS APMs may need to submit the required MIPS data to avoid downward payment adjustment and will not earn the 5 percent bonus. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">The MIPS APM provider may be scored using a special APM scoring standard which accounts for activities required by the APM and attempts to eliminate duplicate submissions of Quality Activity and Improvement. To qualify as a MIPS APM participant it:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Requires an agreement with an APM<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Includes at least one MIPS eligible clinician<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Bases incentive payments on performance in cost, utilization, and quality measures<\/span><\/li>\n<\/ul>\n<h2><span style=\"font-weight: 400;\">Value-Based Care is Here to Stay<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">As providers work to successfully manage their practice and serve their patients, it appears that <a href=\"https:\/\/www.carecloud.com\/continuum\/value-based-care-vs-fee-for-service\/\" target=\"_blank\" rel=\"noopener\">value-based care<\/a> is here to stay. The fifty-percent weight given to quality out of the four reporting measures, and the expectation that cost reporting measures will increase from ten percent to thirty percent by 2019, makes it appear that the key to success is striving for continued reduction in healthcare costs while providing quality patient care. <\/span><\/p>\n<p><span style=\"display: none;\" data-sumome-listbuilder-embed-id=\"63167955acecc7c017d1349e21976b34c69d1681cdcbe88c9a25211c5006fd11\">DUMMYTEXT<\/span><\/p>\n<h4><b>Article Sources<\/b><\/h4>\n<ul>\n<li><a href=\"https:\/\/qpp.cms.gov\/apms\/overview\">https:\/\/qpp.cms.gov\/apms\/overview<\/a><\/li>\n<li><a href=\"http:\/\/www.modernhealthcare.com\/article\/20180629\/NEWS\/180629900\">http:\/\/www.modernhealthcare.com\/article\/20180629\/NEWS\/180629900<\/a><\/li>\n<li><a href=\"https:\/\/revcycleintelligence.com\/news\/macra-quality-payment-program-promotes-alternative-payment-models\">https:\/\/revcycleintelligence.com\/news\/macra-quality-payment-program-promotes-alternative-payment-models<\/a><\/li>\n<li><a href=\"https:\/\/ehrintelligence.com\/features\/what-is-macra-and-what-it-means-to-providers-ehr-technology\">https:\/\/ehrintelligence.com\/features\/what-is-macra-and-what-it-means-to-providers-ehr-technology<\/a><\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was updated by CMS to continue to move healthcare providers from fee-for-service payment, or volume-based, to value-based patient care. As a part of the reform, Quality Payment Program (QPP) policy reforms Medicare Part B payments for clinicians across the country, and is a major step [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":43739,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[389],"tags":[2,42],"class_list":["post-20422","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-resources","tag-growth","tag-leadership"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>2018 Alternative Payment Models (APM) Overview - CareCloud<\/title>\n<meta name=\"description\" content=\"The Alternative Payment Model (APM) and MIPS are the two reimbursement paths used in the Quality Payment Program (QPP). 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