Advanced APMs

Visit our updated Value-Based Reimbursement & Quality Initiatives page to get the latest information on these programs. Learn more

An alternative payment model (APM) is a payment approach that rewards providers for delivering high-quality and cost-efficient care. Advanced APMs are a subset of APMs that let practices earn more rewards in exchange for taking on risk related to patient outcomes.

Advanced APMs are also one of two payment paths under the Quality Payment Program that will be used to determine Medicare Part B payment adjustments. The Advanced APM path is for providers who go the furthest in delivering high-quality, coordinated, and efficient care; successful participation in Advanced APM requirements could earn you a 5% incentive payment beginning in 2019.

2017 Advanced APMs

The Centers for Medicare & Medicaid Services (CMS) will provide a list of care models each year that qualify for Advanced APM incentive payments. In 2017, the following models are Advanced APMs:

• Comprehensive ESRD Care (CEC) – Two-Sided Risk
• Comprehensive Primary Care Plus (CPC+)
• Next Generation ACO Model
• Shared Savings Program – Track 2
• Shared Savings Program – Track 3
• Oncology Care Model (OCM) – Two-Sided Risk
• Comprehensive Care for Joint Replacement (CJR) Payment Model (Track 1- CEHRT)
• Vermont Medicare ACO Initiative (as part of the Vermont All-Payer ACO Model)

Earning the Advanced APM incentive

Only eligible clinicians and groups that participate in qualifying Advanced APMs are eligible for the Advanced APM incentive payments. Providers who are participating in other Medicare payment models — such as Track 1 of the Medicare Shared Savings ACO Program — are not eligible for Advanced APM incentive payments unless their program qualifies as an Advanced APM under CMS rules and they meet certain participation requirements.

Once you’re participating 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

In order to meet Advanced APM Qualifying Participation requirements, you’ll also 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.

If you leave the Advanced APM during 2017, you should make sure you’ve seen enough patients or received enough payments through an Advanced APM to qualify for the 5% bonus. If you haven’t met these thresholds, you should plan to to submit data as part of the MIPS program to avoid a negative 4% payment adjustment in 2019.

Source : Centers for Medicare and Medicaid Services. Quality Payment Program website. February 2016.