The Medicare Access and CHIP Reauthorization Act (MACRA) permanently repealed the flawed sustainable growth rate (SGR) and set up the two-track Quality Payment Program (QPP) that emphasizes value-based payment models.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.
Advanced Alternative Payment Models (AAPMs) offer physicians incentives to provide high-quality, cost-effective care and move away from the fee-for-service (FFS) model. The other QPP participation option is the Merit-based Incentive Payment System (MIPS) track.
To be considered an AAPM, the model must meet three statutory criteria:
An APM that does not meet the criteria to be an AAPM may be considered a MIPS APM.
AAPMs available for primary care include:
For the 2023 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:
QPs will be excluded from the MIPS reporting requirements. Partial QPs can opt to participate in MIPS. Partial QPs who elect to participate in MIPS must report through Traditional MIPS or the APM Performance Pathway (APP).
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.
Additional resources, including the full list of Medicare and Other Payer AAPMs, are available in the resource library of the Quality Payment Program website.
CMS makes QP determinations three times a year (March 31, June 30, and August 31) using an AAPM Entity’s participation list. Advanced Alternative Payment Model participants can check their QP status using the QPP Participation Status Tool.
For payment year 2025, QPs will receive a 3.5% lump-sum bonus based on the previous year’s Medicare Part B payments.
Qualifying participants (QPs) will receive a 0.75% increase to their Medicare physician fee schedule (PFS) beginning in 2026.