MACRA introduced the Quality Payment Program (QPP) in 2015, officially phasing out the Sustainable Growth Rate (SGR) formula and replacing it with two payment tracks: MIPS and Advanced APM. The latter, known as the Advanced Alternative Payment Models (APMs), offer incentives to providers that handle a given number of payments or patients in a given performance year.
What are the Advanced Alternative Payment Models (APMs)?
Under the Quality Payment Program, providers can choose between the MIPS payment track or the Advanced Alternative Payment Models (APMs). With the latter, providers attempt to meet the participation thresholds, which require them to process a certain number of payments or patients in a given year. Providers that meet the thresholds can become qualifying APM participants (QPs).
Once providers become QPs, they are excluded from MIPS reporting requirements and the corresponding payment adjustments. Instead, they receive incentives such as an additional 5% payment for performance years 2017 to 2022 and a higher physician fee schedule for 2024 and after.
The most recent participation thresholds to become a QP are based on percentages of an APM Entity. A solo practitioner, a group of practitioners sharing a TIN, or a combination of practitioners and clinicians with different TINs can form an entity.
Requirements of an APM
New participation thresholds are set each year to determine if providers are eligible to become qualifying APM participants, which excludes them from MIPS requirements and introduces new incentives.
In addition to meeting the thresholds, participants must achieve a few other requirements, including using certified EHR technology (CEHRT) and reporting on quality measures, similar to the MIPS quality performance measures. Lastly, in exchange for added incentives, APM participants are expected to accept some additional financial risk (e.g., a higher risk of losing money).
How TempDev Can Help With Your Advanced APM
TempDev’s team of experienced consultants, developers, and trainers are here to support enhanced accessibility, as well as customized features and templates. This gives you and your patients more control over data with improved transparency.
As part of our streamlining process, we help you implement the Patient Portal, API, and other tools better to support safety, patient engagement, and security. From dashboards to automation and workflow redesign, TempDev offers the comprehensive resources and tools you need to implement and be compliant with your Advanced APM.
Contact us here or by calling us at 888.TEMP.DEV to optimize your APM reporting requirements.