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APMs Overview

An Alternative Payment Model (APM) is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population.

Advanced APMs are a subset of APMs, and let practices earn more for taking on some risk related to their patients' outcomes. You may earn a 5% incentive payment by going further in improving patient care and taking on risk through an Advanced APM.

What models are Advanced APMs?

In 2017, the following models are Advanced APMs:

Almost 100% of eligible clinicians in the following Advanced APMs will be Qualifying APM Participants (QP) based on performance year 2017 - meaning that they will be eligible to receive a 5% APM Incentive Payment in 2019. An unauthenticated QP determination status lookup QP Lookup Tool is available for eligible clinicians to review.

There are approximately 75,000 NPIs included in this initial QP analysis. This assessment was completed using Medicare claims with dates of service between January 1, 2017 and March 31, 2017 that were processed between January 1, 2017 and June 30, 2017 and APM participation lists as of March 31, 2017.

Here’s the list of Advanced APMs included:

  • Next Generation ACO Model. All eligible clinicians on Next Generation ACO Model participation lists as of March 31, 2017, met a QP Threshold.
  • Comprehensive ESRD Care (CEC) Model - Two-Sided Risk. All eligible clinicians on CEC Model participation lists as of March 31, 2017, met a QP Threshold.
  • Comprehensive Primary Care Plus (CPC+) Model. Almost 100% (99.5% of APM Entities) met either QP or Partial QP status. APM Entities in CPC+ that did not meet the QP Threshold, including those that achieved the Partial QP Threshold, have been contacted directly by CMS to discuss their QP status.
  • Medicare Shared Savings Program - Track 2. All eligible clinicians on Shared Savings Program Track 2 participation lists as of March 31, 2017, met a QP Threshold.
  • Medicare Shared Savings Program - Track 3. All eligible clinicians on Shared Savings Program Track 3 participation lists as of March 31, 2017, met a QP Threshold.

These results do not reflect all Advanced APMs for performance year 2017. Although the Oncology Care Model (OCM)—Two-Sided Risk Arrangement and the Comprehensive Care for Joint Replacement Model (CJR)—CEHRT Track are Advanced APMs for performance year 2017, we did not yet calculate QP Thresholds for eligible clinicians in these models. We’ll release the second and third QP determinations later this year.

The Methodology Fact Sheet can help you understand how we determined the QP Status based on eligible clinician performance through March 31, 2017.

How do I join an Advanced APM?

  1. Learn about specific Advanced APMs and how to apply.
  2. Apply to an Advanced APM that fits your practice and is currently accepting applications.
  3. This website will be updated as new information is available.

What happens if I am in an Advanced APM?

Once you're 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

You'll 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 may need to submit MIPS data to avoid a downward payment adjustment.

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