As we mentioned in the last post, both MIPS and Advanced APMs are a part of the Quality Payment Programs. These programs replace the reimbursement structure in place for practices in 2017. So what is the difference between MIPS and Advanced APMs? CMS estimates that the vast majority of Clinicians will be subject to MIPS, while a small minority will be able to be classified as Qualified Practitioner (QP) under Advanced APMS.
Advanced Alternative Payment Models (APMs) are the movement in U.S. health care to reward providers for the value of their services. The various APMs will reward providers who deliver high-quality care while keeping costs low. While these payment models are complex, a portion of the reimbursement will be made under the Medicare Physician’s Fee Schedule. As far as those reimbursements are concerned, clinicians who participate in an Advanced APM and who are classified as a QP will receive a 5% lump sum bonus payment on top of the prior year’s reimbursements.
APMs have been around for a while, but MACRA steps those programs up a notch. Some examples of current APMs are: Accountable Care Organizations (ACO) under the Medicare Shared Savings Program, the Comprehensive Primary Care initiative and Patient Centered Medical Homes. These programs will continue to be considered APMs. However, for a clinician to be considered a QP they must practice as a part of an Advanced APM.
The Advanced APM requires Clinicians take on more risk for care. An example of risk-based reimbursement are the “bundled” payments used by Medicare to pay for joint replacements. The hospital gets a lump sum for the surgery, pre-op, post-op and any other care needed due to that replacement. Medicare will not reimburse the hospital if the patient is readmitted with problems due to that replacement, so the provider takes some risk.
All of this said, even those practices that are currently classified as an ACO or other Advanced Payment Model will likely be subject to MIPS for the first several years of the program.
So what is MIPS? Find out in our next post, What the MIPS!?.
