APM
APM - Alternative Payment Models
MACRA repealed the Sustainable Growth Rate formula and created the Quality Payment Program. The Quality Payment Program changes the way Medicare pays clinicians and streamlines multiple quality programs. There are two options to choose from based on practice size, specialty, location or patient population. These are MIPS and APM (Advanced Alternative Payment Models). In APM, incentives are earned by achieving thresholds levels of payments or patients which will exclude you from MIPS.
Advanced APMs: Eligible for 2017
- Medicare Shared Savings Program – Track 2
- Medicare Shared Savings Program – Track 3
- Next Generation ACO Model
- Comprehensive Primary Care Plus (CPC+)
- Comprehensive ESRD Care Model (Large Dialysis Organization arrangement)
- Oncology Care Model Two-Sided Risk Arrangement (started 2018)
Omissions
- Medicare Shared Savings Program – Track 1
- Comprehensive Joint Replacement
- Patient Centered Medical Homes – only count for MIPS so far
Basic Scoring Process
Base Measure - 50 points (all or nothing)
*Primary option: 11 measure many Stage 3 measure
| Measure | Stage 2 | Stage 3 |
|---|---|---|
| Security Risk Analysis | ||
| ePrescribing | ||
| Patient Access | ||
| Patient-Specific Education | ||
| View, Download or Transmit (VDT) | ||
| Secure Messaging | ||
| Patient-Generated Health Date | ||
| Patient Care Record Exchange | ||
| Request/Accept Patient Care Record | ||
| Clinical Information Reconciliation | ||
| Immunization Registry Reporting | ||
| (Optional) Syndromic Surveillance Reporting | ||
| (Optional) Electronic Case Reporting | ||
| (Optional) Clinical Data Registry Reporting |
*Alternate Option: 16 measures all Stage 2
| Measure | Stage 2 | Stage 3 |
|---|---|---|
| Security Risk Analysis | ||
| ePrescribing | ||
| Clinical Decision Support Ineractions (CDS) | ||
| Drug Interaction and Drug-Allergy Checks | ||
| Medication Orders | ||
| Laboratory Orders | ||
| Diagnositic Imaging Orders | ||
| Patient Access | ||
| View, Download or Transmit (VDT) | ||
| Patient-Specific Education | ||
| Secure Messaging | ||
| Health Information Exchange | ||
| Medication Reconciliation | ||
| Immunization Registry | ||
| Syndromic Surveillance | ||
| Specialized Registry Reporting |
Performance Measure - Up to 80 points
- 3 Stage 3 measures - up to 10pts each
- 5 Stage 2 measures - up to 10 pts each
| Measure | Stage 2 | Stage 3 |
|---|---|---|
| Timely Access | ||
| Patient Education | ||
| View, Download, Transmit VDT | ||
| Secure Messaging | ||
| Patient Generated Health Data | ||
| Patient Care Record Exchange | ||
| Request, Accept Patient Care Record | ||
| Clinical Information Reconciliation |
Registry bonus - 1 point for doin at least one extra registry extra beyond immunization
- Syndromic Surveillance
- Elecrtonic Case Reporting
- Public Health Registry Reporting
- Clinical Data Registry Reporting
APM Performance Categories and Weights
- Quality: 50 percent
- Cost: 0 percent
- Improvement activities: 20 percent
- Promoting interoperability: 30 percent
APM Participation Incentive
- Current incentives for APMs remain in place
- 2019-2024 - MIPS participation waived
5% Medicare Part B Incentive
- 2026 and forward: MIPS participation waived
Higher fee schedule update