The Medicare Access and CHIP Reauthorization Act (MACRA) permanently repealed the flawed sustainable growth rate (SGR) and set up the two-track Quality Payment Program (QPP) that emphasizes value-based payment models. This is your guide to the Advanced Alternative Payment Model (AAPM) track.
The Advanced Alternative Payment Model (AAPM) offers physicians incentives to provide high-quality, cost-effective care and move away from the fee-for-service (FFS) model. The other track created under MACRA is the Merit-based Incentive Payment System (MIPS) track.
AAPMs available for primary care include:
For the 2020 performance period, an AAPM entity must do one of the following for all its eligible clinicians to be qualifying participants (QPs):
Eligible clinicians that are not considered QPs can be considered partial QPs if the AAPM entity meets at least one of the following thresholds:
ECs can also achieve QP status through the All-Payer Combination Option. This option allows ECs who do not meet the QP patient or payment threshold under their Medicare AAPM to count their participation in an Other Payer APM toward their QP status. The payment and patient thresholds remain the same under the All-Payer AAPM option, 50% and 35% respectively. However, an EC can reach these thresholds through a combination of payments or patients seen through the Medicare AAPM and the Other Payer AAPM. To become a QP through the All-Payer Combination Option, an EC must still meet minimum thresholds under the Medicare arrangement. ECs must:
An EC can be considered a partial QP through the All-Payer Combination Option if they meet the payment or patient threshold, 40% and 25% respectively. Partial QPs must meet the following minimum Medicare thresholds:
APM entities or eligible clinicians can request that CMS use the All-Payer Combination Option to determine their QP status. Entities and ECs must submit payment and patient data from their Other Payer APM for CMS to make this determination.
Qualifying participants (QPs) will receive an annual 5% lump-sum bonus. The bonus is based on the previous year’s Medicare Part B payments. The bonus applies in payment years 2019-2024.
Qualifying participants (QPs) will receive a 0.75% increase to their Medicare physician fee schedule (PFS) beginning in 2026.