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Content Category: Practice Management

Practice Management

APM Guide

Risk & reward

Earn incentives for providing a patient pool with quality cost-effective care

Physicians who successfully achieve APM payment or patient threshold levels are excluded from MIPS reporting requirements.

The second track of the CMS Quality Payment Program is advanced Alternative Payment Models (APMs). Advanced APMs provide extra incentives for providing high-quality, cost-effective care for a specific pool of patients by requiring practices to take on two-sided financial risk.

For 2018, if you participate in an advanced APM, you can earn up to a 5% bonus, which will be awarded in 2020. To earn the bonus, you must earn 25% of your Medicare Part B revenue through the advanced APM or treat 20% of your Medicare patients through the advanced APM. If you’re at risk of not meeting those benchmarks, most advanced APMs allow you to submit MIPS data for 2018 so you can avoid getting a penalty in 2020.

If you participated in an APM for the 2017 performance year, you can use this CMS tool to see whether you achieved qualified participant status.

2018 APM options

For 2018, the CMS recognizes nine APM models. To join one, you’ll need to choose one that fits your practice and check to see whether it’s accepting applications.

APM benchmarks

APMs require two-sided financial risk, which means that while your practice could potentially lose money, you also stand to gain revenue. Here’s the setup:

  • 2018-2020:  To earn the 5% bonus, 25% of all your Medicare revenue must be in advanced APMs, or you must have seen 20% of your Medicare patients through an advanced APM.
  • 2021-2022: 50% of all your Medicare revenue must be in APMs, or 25% of all your Medicare revenue and 50% of your revenue from all payers must be in advanced APMs.
  • 2023 and on: 75% of all your Medicare revenue must be in advanced APMs, or 25% of all your Medicare revenue and 75% of your revenue from all payers must be in APMs.

Leaving an APM

If your practice leaves an advanced APM in 2018, be sure you’ve seen enough patients or earned enough advanced APM revenue, as described above, to earn the 5% bonus. If you haven’t met the benchmarks above, you’ll need to submit MIPS data so as not to get a penalty in 2020. Learn more.

Getting help

AOA members can contact the AOA for free, personalized assistance with APMs and the Quality Payment Program. Physicians can also contact CMS at (866) 288-8292 or qpp@cms.hhs.gov.