An Alternative Payment Model is a Payment approach that gives incentive payments for providing high-quality and cost-efficient care. It means that provider will receive incentive for special services not only for high quality care but also not expensive care.
There are some options of Alternative Payment Models that can be tried:
CMS Quality Payment Program divided into subcategories, Alternative Payment Models (APMs) and Merit-Based Incentive Payment system (MIPS) so providers can choose through which of them they prefer to get payment. So all of this happens since 2017, and is really one of the major changes that we saw to move to Alternative Payment Models and concentrating on quality and step away from high cost care.
There is a various types of APMs
Advanced Alternative Payment Models offers more incentive, so earn more but also get more risk. It Requires Doctor’s medical office to use Certified Electronic Health Record technology. Provide payment for the covered professional services based on quality measures used in MIPS quality performance category and be a Medical Home Model under CMS innovation Center or participating APM entities with more than nominal amount of financial risk losses. The volume must be 25% of Medicare Part B payments OR 20% of Medicare patients.
Reporting data are scored: A higher score means payment incentives, a lower or no score means a payment penalty.
For each performance year, the CMS determines and lists whether the APM meets the requirements of the extended APM. Alternative Payments Models in Quality Payment Program as of February 2018 presented at the following table that the CMS operates.
|APM||MIPS APM under the APM Scoring Standard||Medical Home Model||Use of CEHRT Criterion||Quality Measures Criterion||Financial Risk Criterion||Advanced APM|
|Accountable Health Communities (AHC)||no||no||no||no||no||no|
|ACO Investment Model (AIM)||no||no||no||no||no||no|
|Bundled Payments for Care Improvement Model 2 (BPCI)||no||no||no||no||YES||no|
|Bundled Payments for Care Improvement Model 3 (BPCI)||no||no||no||no||YES||no|
|Bundled Payments for Care Improvement Model 4 (BPCI)||no||no||no||no||YES||no|
|Bundled Payments for Care Improvement Advanced Model (BPCI Advanced) ***||YES||no||YES||YES||YES||YES|
|Comprehensive Care for Joint Replacement (CJR) Payment Model (Track 1 - CEHRT)||no||no||YES||YES||YES||YES|
|Comprehensive Care for Joint Replacement (CJR) Payment Model (Track 2 - non-CEHRT)||no||no||YES||YES||YES||No|
|Comprehensive ESRD Care (CEC) Model (LDO arrangement)||YES||no||YES||YES||YES||YES|
|Comprehensive ESRD Care (CEC) Model (non-LDO two-sided risk arrangement)||YES||no||YES||YES||YES||YES|
|Comprehensive ESRD Care (CEC) Model (non-LDO arrangement one-sided risk arrangement)||YES||no||YES||YES||no||no|
|Comprehensive Primary Care Plus (CPC+) Model *******||YES||YES||YES||YES||YES||YES|
|Frontier Community Health Integration Project Demonstration (FCHIP)||no||no||no||no||no||no|
|Home Health Value-Based Purchasing Model (HHVBP)||no||no||no||YES||no||no|
|Independence at Home Demonstration (IAH)||no||no||no||YES||no||no|
|Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents: Phase 2||no||no||no||no||no||no|
|Medicare Accountable Care Organization (ACO) Track 1+ Model||YES||no||YES||YES||YES||YES|
|Medicare Patient Intravenous Immunoglobulin (IVIG) Access Demonstration Project||no||no||no||no||no||no|
|Maryland All-Payer Hospital Model||no||no||no||no||YES||no|
|Medicare Advantage Value-Based Insurance Design (VBID) Model||no||no||no||no||no||no|
|Medicare Care Choices Model (MCCM)||no||no||no||no||no||no|
|Medicare-Medicaid Financial Alignment Initiative *****||N/A||N/A||N/A||N/A||N/A||N/A|
|Medicare Shared Savings Program Accountable Care Organizations — Track 1||YES||no||YES||YES||no||no|
|Medicare Shared Savings Program Accountable Care Organizations — Track 2||YES||no||YES||YES||YES||YES|
|Medicare Shared Savings Program Accountable Care Organizations — Track 3||YES||no||YES||YES||YES||YES|
|Million Hearts: Cardiovascular Disease Risk Reduction Model (MH CVDRR)||no||no||no||YES||no||no|
|Next Generation ACO Model||YES||no||YES||YES||YES||YES|
|Oncology Care Model (OCM) (one-sided Risk Arrangement)||YES||no||YES||YES||no||no|
|Oncology Care Model (OCM) (two-sided Risk Arrangement)||YES||no||YES||YES||YES||YES|
|Part D Enhanced Medication Therapy Management Model||no||no||no||no||no||no|
|Pennsylvania Rural Health Model||no||no||YES||no||YES||no|
|Prior Authorization of Repetitive Scheduled Non- Emergent Ambulance Transport||no||no||no||no||no||no|
|Prior Authorization of Non-Emergent Hyperbaric Oxygen Therapy Model||no||no||no||no||no||no|
|State Innovation Models — Round 1 (SIM 2) ******||N/A||N/A||N/A||N/A||N/A||N/A|
|State Innovation Models — Round 2 (SIM 2)*******||N/A||N/A||N/A||N/A||N/A||N/A|
|Transforming Clinical Practice Initiative (TCPI)||no||no||no||no||no||no|
|Vermont Medicare ACO Initiative (as part of the Vermont All-Payer ACO Model) ********||YES||no||YES||YES||YES||YES|
* BPCI Advanced is scheduled to begin in October 2018, and participants will have an opportunity to achieve QP status, or be scored under the APM scoring standard for MIPS, starting in performance year 2019.
** APM Entities must include at least one MIPS eligible clinician on a Participation List in order to be scored under the APM scoring standard. Some eligible clinicians in BPCI Advanced may be Affiliated Practitioners, and thus not scored under the APM scoring standard. If those eligible clinicians are not QPs for a year, they may be subject to MIPS reporting requirements and payment adjustments for that year.
*** Dual participants in CPC+ and the Medicare Shared Savings Program will have their APM status determined by the Medicare Shared Savings Program track in which they participate, and not by CPC+.
**** For practices that begin CPC+ participation in 2018 with more than 50 eligible clinicians in their parent organization will not qualify under the Medical Home Model financial risk standard, and therefore will not be considered to be participating in an Advanced APM.
***** The Medicare-Medicaid Financial Alignment Initiative agreements are between CMS and state and health plan participants. For the capitated financial alignment model, CMS will assess agreements between health plans and health care providers as other payer arrangements under the All-Payer Combination Option.
****** SIM Round 1 has one remaining state grant that will end in April, 2018.
******* SIM Round 2 provides financial and technical support to 11 states to test and evaluate multi-payer health system transformation models. CMS will assess agreements between states and health care providers as other payer arrangements under the All-Payer Combination Option.
******** Vermont ACOs will be participating in an Advanced APM and a MIPS APM during 2018 through their participation in a version of the Next Generation ACO Model