Do We Qualify as an APM?

Advanced Payment Model (APM) participants must carry a specific amount of financial risk by accepting both risk and reward for providing coordinated, high-quality and efficient care for the lowest.

As defined by MACRA, APM’s include:

  • CMS Innovation Center model (under section 1115A, other than a Health Care Innovation Award)
  • MSSP (Medicare Shared Savings Program)
  • Demonstration under the Health Care Quality Demonstration Program
  • Demonstration required by federal law

Clinicians who have participated in Medicare for less than one year or have less than or equal to $10,000 in Medicare charges and less than or equal to 100 Medicare patients are not eligible for AAPM participation.

APMs include Bundled Payments models, Accountable Care Organizations (ACOs), and Patient-Centered Medical Homes (PCMHs), and others. APMs that do not qualify as Advanced APMs will retain APM-specific rewards but are required to participate in MIPS but will benefit from favorable scoring in the clinical practice improvement activities performance category (CPIA).

Advanced APMs (AAPM)

An Advanced Alternative Payment Model, or AAPM, is one of the two new provider payment pathways under MACRA’s new Quality Payment Program (QPP) and is held to an even higher standard than current APMs (i.e.: ACOs, bundled payments, MSSP track 1, etc.). Essentially, an AAPM serves more people, with better technology, and with greater accountability.

To be deemed an Advanced APM, an APM participant must also:

  • Utilize certified EHR technology to document and communicate care (with at least 50 percent of APM clinician utilization).
  • Base payment measures on MIPS comparable quality performance category measures.
  • Have a higher minimum threshold for patient-facing cases, or more in-person visits.
  • Take on “not nominal risk” of at least 4%.