An Alternative Payment Model (APM) is an approach to payment, developed in partnership with clinician communities, providing incentives to clinicians to provide high-quality and cost-effective care. Clinicians must apply or be invited to participate in an APM.
Examples of the approved MIPS-APMs and Advanced APMs for 2021 include:
- Bundled Payments for Care Improvement Advanced Model (BPCI Advanced)
- Comprehensive ESRD Care (CEC) Model LDO Arrangement, non-LDO Two-Sided Risk Arrangement, non-LDO one-Sided Risk Arrangement
- Comprehensive Primary Care Plus (CPC+)
- Medicare Accountable Care Organization (ACO) Track 1+ Model
- Next Generation ACO Model
- Medicare Shared Savings Program – Track 1, Track 2, Track 3
- Oncology Care Model (OCM) - Two-Sided Risk, One-Sided Risk
For a full list of Approved APMS visit Quality Payment Program.
Clinicians who participate successfully in an APM may be exempt from MIPS reporting and have the potential to earn a 5% Medicare incentive payment during 2019 through 2024. Clinicians can use the APM Lookup Tool to check their Qualifying APM Participant (QP) status.
Each APM Type has unique requirements, please contact your APM program coordinator to discuss program and technology requirements.
Important facts to know about APMs:
- APMs are Medicare Incentive Programs.
- They are usually managed by local medical entities such as hospitals, medical groups or Independent Physician Associations (IPAs).
- Participating providers might also be required to participate in the MIPS track.
- APM administrators assign quality measures to participating providers.
Types of APM classification:
- MIPS APMs
- Advanced MIPS APM
- All-Payer /Other-Payer Option
APM Performance Pathway (APP)
The APM Performance Pathway (APP) is a MIPS reporting and scoring pathway for MIPS eligible clinicians who participate in MIPS APMs. The APP is in effect starting January 1, 2021 and is an optional reporting and scoring for MIPS APMs participants however, it is required for all Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs).
APP participants will be scored on a single, pre-determined measure set across three categories:
- Quality 50%
- Promoting Interoperability 30%
- Improvement Activities 20%
The cost performance category is weighted at 0% of the MIPS Final Score for MIPS APM participants reporting through the APP, as all MIPS APM participants are already responsible for costs under their APMs.
Measures included in the APP and are supported by Kareo are:
- CMS 122: Diabetes Hemoglobin A1C Poor Control (9.0%)
- CMS 2: Preventive Care and Screening: Screening for Depression and Follow-up Plan
- CMS 165: Controlling High Blood Pressure
- CMS 147: Preventive Care and Screening: Influenza Immunization
- CMS 138: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
- CMS 130: Colorectal Cancer Screening
- CMS 125: Breast Cancer Screening
For the full list of quality measures in the APP visit https://qpp.cms.gov/.