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We strive here to explain in one narrative the key aspects of APMs, as updated for the 2018 performance year, both for those new to APMs as well as those with previous familiarity. The FAQs are optimally read in sequential order but are also sufficiently standalone (with linking across FAQs) to enable skipping to the one of greatest interest.
On November 2, 2017, CMS released the 2018 Quality Payment Program (QPP) final rule (easier-to-read format here) in accordance with one of the most bipartisan and significant legislative changes to Medicare in a generation, the Medicare Access and CHIP Re-authorization Act of 2015 (MACRA). MACRA repeals the legacy Medicare Part B Sustainable Growth Rate (SGR) reimbursement formula and replaces it with the QPP, a new value-based reimbursement system impacting Part B payments to clinicians nationally. The QPP consists of two major tracks:
- The Merit-based Incentive Payment System (MIPS)
- Alternative Payment Models (APMs)
CMS predicts that 185,000 to 250,000 clinicians in 2018 will participate in Advanced APMs. Advanced APMs are value-based payment programs operated by CMS which meet minimum requirements for the use of certified EHR technology, quality measurement, and the level of financial risk placed upon clinicians. These minimum requirements distinguish Advanced APMs from APMs generally. Qualifying participants in Advanced APMs can earn an annual 5% Medicare Part B incentive (paid 2019 – 2024) and an exemption from MIPS. In addition, starting in 2026, Advanced APM qualifying participants will accrue a higher annual Part B physician fee schedule (PFS) increase of 0.75%, rather than 0.25% for other clinicians.
Read on for some of the most frequently asked questions about APMs and Advanced APMs, in particular.