What is the Advanced Alternative Payment Model (AAPM)?
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The document discusses the Advanced Alternative Payment Model (AAPM) introduced by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, which aims to transition clinicians from a fee-for-service model to value-based care. It outlines the criteria and benefits for qualifying as an AAPM, including exemptions from the Merit-Based Incentive Payment System (MIPS) and financial risk assumptions. Additionally, it notes that there are currently 49 alternative payment model entity groups, with only 14 qualifying as advanced AAPMs.
![The Medicare Access and CHIP
Reauthorization Act (MACRA) of 2015 began a
reformation of modern healthcare from fee-
for-service (FFS) to value-based care. Among
other policies, MACRA legislation repealed the
Medicare Part B Sustainable Growth Rate
(SGR) reimbursement methodology, and it
initialized a phasing out of the Medicare
Physician Fee Schedule (PFS). In addition,
MACRA legislation introduced the Quality
Payment Program (QPP), a new, more
streamlined performance-based payment
system consisting of two scoring and
reimbursement frameworks:
The Merit-based Incentive Payment
System (MIPS) [and]
The Advanced Alternative Payment Model
(AAPM) system.](https://image.slidesharecdn.com/whatistheaapmslide-share1-180126154909/85/What-is-the-Advanced-Alternative-Payment-Model-AAPM-2-320.jpg)
What is the Advanced Alternative Payment Model (AAPM)?
- 2. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 began a reformation of modern healthcare from fee- for-service (FFS) to value-based care. Among other policies, MACRA legislation repealed the Medicare Part B Sustainable Growth Rate (SGR) reimbursement methodology, and it initialized a phasing out of the Medicare Physician Fee Schedule (PFS). In addition, MACRA legislation introduced the Quality Payment Program (QPP), a new, more streamlined performance-based payment system consisting of two scoring and reimbursement frameworks: The Merit-based Incentive Payment System (MIPS) [and] The Advanced Alternative Payment Model (AAPM) system.
- 3. Both frameworks are regulatory “environments” that establish performance measurements used to score clinicians to determine payment adjustments and bonuses.
- 4. Whereas the Merit-based Incentive Payment System is the default scoring and performance pathway in the QPP, the Advanced Alternative Payment Model (AAPM) is the most advanced scoring and performance pathway.
- 5. what is the AAPM? The goal of the Quality Payment Program’s Medicare reform is to gradually move clinicians from solely practicing under MIPS, to practicing under an Alternative Payment Model (APM), to ultimately practicing under the Advanced Alternative Payment Model (AAPM). An APM is an “in- between” payment structure that incorporates a modified MIPS and APM Scoring Standard. Advanced APMs are often referred to as “subsets” of APMs; however, this is misleading, because Advanced APMs are an “advanced” form of the Alternative Payment Model, a higher level of APM participation, exempt from MIPS.
- 6. UNDERSTANDING THE ADVANCED ALTERNATIVE PAYMENT MODEL Each year the Centers for Medicare and Medicaid Services (CMS) invites clinicians and organizations to propose new payment models for consideration as Advanced APMs. Advanced APM entity groups coordinate and agree with CMS to adhere to higher levels of healthcare criteria; specifically, Advanced APMs take on a greater amount of “downside risk,” or “two-sided risk.” Because Advanced APMs manage greater financial risk, CMS exempts them from the MIPS reporting system and any payment adjustments, and CMS rewards them with a 5% lump sum performance bonus.
- 7. To qualify as an Advanced APM (AAPM), the entity group must meet the following CMS eligibility requirements:
- 8. A A P Pay for professional services that record Quality Measures comparable to those used in the quality performance category of MIPS. Require at least 50% of participants to use Certified Electronic Health Record Technology (CEHRT). Assume more than a “nominal amount” of financial risk for monetary losses or be a Medical Home Model expanded under the Center for Medicare and Medicaid Innovation (CMMI) authority.M
- 9. Each year CMS provides a list of care models that qualify as Advanced APMs. For 2018, the following models are considered Advanced APMs:
- 10. A A P Comprehensive ESRD Care Model (LDO and Non-LDO arrangements) Comprehensive Primary Care Plus (CPC+) Medicare Shared Savings Program (MSSP ACOs Track 2 and Track 3) Next Generation ACO Model Oncology Care Model (only two-sided risk arrangements) Comprehensive Care for Joint Replacement (CJR) Payment Model (Track 1 – CEHRT) Vermont Medicare ACO Initiative (as part of the Vermont All-Payer ACO Model) M
- 11. A A P Cardiac Rehabilitation (CR) Incentive Payment Model Acute Myocardial Infarction (AMI) Model (Track 1 – CEHRT) Coronary Artery Bypass Graft (CABG) Model (Track 1 – CEHRT) Medicare-Medicaid Accountable Care Organization Model (MMACO Tracks 2 and 3) Advancing Care Coordination through Episode Payment Models Tracks 1 and 2 Medicare ACO Track 1+ Surgical Hip/Femur Fracture Treatment (SHFFT) Model (Track 1 – CEHRT) M
- 12. At the time of this article, there were approximately 49 qualifying Alternative Payment Model (APM) entity groups listed in the Quality Payment Program (QPP) and only 14 of those meet the requirements as an Advanced APM entity group. http://www.insight-txcin.org/post/understanding-the- advanced-alternative-payment-model
- 14. ABOUT TXCIN North Texas Clinically Integrated Network, Inc. (dba TXCIN) is a non-profit ACO that began in late 2014. A small group of independent physicians aligned to initiate clinical integration and value- based contracting. Partnering with RevelationMD and its state-of-the art information platform, TXCIN has become the largest independent network of physicians in North Texas.