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Quality & Practice

Alternative Payment Models (APMs)


Within the Quality Payment Program, there are 2 paths providers can choose and use to report quality data:

 

Most Medicare clinicians will initially participate in the Quality Payment Program through MIPS to earn a performance-based payment adjustment. Clinicians who take a further step towards care transformation may participate in Advanced APMs to earn a Medicare incentive payment for participating in an innovative payment model. Initially this will only include Advanced APMs that focus on Medicare, but starting in 2019 it will also include clinicians’ participation in Medicaid and private payer arrangements. Learn more about Medicaid and the QPP.

 

What are APMs and Advanced APMs?

An APM is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population.

Advanced APMs are a subset of APMs, and let practices earn more for taking on some risk related to their patients' outcomes. You may earn a 5% incentive payment by going further in improving patient care and taking on risk through an Advanced APM. 

Which models are APMs?

Please note: APMs are not limited to CMS. There are many available through commercial insurers. 

Which models are Advanced APMs?

How do I join an Advanced APM?

  1. Learn about the 2017 Advanced APMs and how to apply by clicking the links above.
  2. Ensure your desired Advanced APM is currently accepting applications
  3. Follow the application instructions on the Advanced APM's webpage. Please note: the application process can be time consuming. Contact CMS or the insurance provider leading the APM for assistance. 

 

What happens if I am in an Advanced APM?

Once you're in an Advanced APM, you'll earn the 5% incentive payment in 2019 for Advanced APM participation in 2017 if:

  • You receive 25% of your Medicare Part B payments through an Advanced APM or
  • See 20% of your Medicare patients through an Advanced APM

You'll need to send in the quality data required by your Advanced APM. Your model's website will tell you how to send in your Advanced APM's quality data.

 

Where can I learn more?

Please note: due to the risk involved, it is important to understand your options thoroughly.