Alternative Payment Models (APMs) Preview

Posted by Continuum on Jun 7, 2016 11:00:00 AM

As healthcare shifts from a fee-for-service to a value-based system, Medicare is making sweeping changes to how it VB_Care_Payment_Model.jpgreimburses physicians. The Centers for Medicare and Medicaid Services (CMS) has introduced new regulations and reporting requirements – as well as unprecedented potential for financial rewards and penalties. 

Indeed, doctors who achieve the highest levels of “value” will earn substantial increases in their Medicare Part B payments. Conversely, those who do little or nothing to address the new requirements will incur significant reductions. Commercial payers are adopting similar models, further expanding the potential impact of these changes – positive or negative – on a practice.

Physicians need to start acting now, so as not to fall behind and put their practices at risk. Fortunately, doctors don't have to do it alone: a qualified enablement partner can efficiently manage this transition.

Choose your path

The Medicare Access & CHIP Reauthorization Act (MACRA) of 2015 created the Quality Payment Program (QPP), which offers physicians a choice between two different reporting paths. Both start in the 2017 reporting year:

  • The Merit-Based Incentive Payment System (MIPS). This new structure encompasses CMS’s current models for measuring physician quality and cost of care, and adds “clinical practice improvement” activities, such as expanding patient access or being a patient-centered medical home. For more information on MIPS and an overview of healthcare’s transformation to “value,” please see our previous white paper: How Physicians Can Win in the New Healthcare Environment 2016 is Key Year to Act – or Lose Ground.
  • Advanced Alternative Payment Models (APMs). These are payment arrangements in which clinicians accept financial risk for providing coordinated, high-quality care. As an incentive to take on this risk, CMS offers increased monetary rewards. CMS has designated specific payment models as Advanced APMs – including certain medical homes, accountable care organizations (ACOs) and bundled payment models -- and it will continue to approve new models. Advanced APMs are similar to one another, with variations based primarily on the different quality measures they use – such as those for primary care, oncology, and end-stage renal disease.

For more information on APMs, look for our next whitepaper coming soon!The New Gold Standard in Quality Reimbursement: Alternative Payment Models; Should Your Practice Reach for the Gold?


Topics: value-based reimbursement, CMS, Alternative Payment Models

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