APM

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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MACRA repealed the Sustainable Growth Rate formula and created the Quality Payment Program.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