What are Advanced Alternative Payment Models (AAPMs)?

MACRA Basics

Advanced Alternative Payment Models (AAPMs)

The Medicare Access and CHIP Reauthorization Act (MACRA) permanently repealed the flawed sustainable growth rate (SGR) and set up the two-track Quality Payment Program (QPP) that emphasizes value-based payment models. 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. 

AAPM Overview

The AAPM is one of the two new payment tracks created under MACRA; the other track is the Merit-based Incentive Payment System (MIPS).

AAPMs available for primary care include:

  • Comprehensive Primary Care Plus (CPC+)
  • Medicare Shared Savings Program (MSSP) Tracks 1, 2, and 3
  • Medicare Accountable Care Organization (ACO) Track 1+
  • Next Generation ACO Model
  • Vermont Medicare ACO initiative (as part of the Vermont All-Payer ACO Model)
  • Additional models will be announced by CMS as they are approved

For the 2018 performance period, an AAPM entity must do one of the following for all of its eligible clinicians to be qualifying participants (QPs):

  • Receive at least 25% of its Medicare Part B payments through the AAPM, or
  • See at least 20% of its Medicare patients through the AAPM

Eligible clinicians that are not considered QPs can be considered partial QPs if the AAPM entity meets at least one of the following thresholds:

  • Receive at least 20% of it Medicare Part B payments through the AAPM, or
  • See at least 10% of it Medicare Part B patients through the AAPM.

QPs will be excluded from the MIPS reporting requirements. Partial QPs can opt to participate in MIPS and will be scored using the APM Scoring Standard.

Advanced Alternative Payment Model participants can check their QP status using the QP Lookup Tool(data.cms.gov).

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.