Others titles
- APMs in the Quality Payment Program
- CMS Alternative Payment Models
Keywords
- Alternative Payment Models
- APMs
- Quality Payment Program
- Advanced APM Criteria
- MIPS APMs
APM in Quality Payment Program
This dataset shows the Alternative Payment Models (APMs) that CMS (Centers for Medicare & Medicaid Services) operates. The dataset identifies which of those APMs CMS has determined to be advanced APMs, unless otherwise noted. The information presented in the dataset applies the Advanced APM criteria adopted in the Quality Payment Program final rule to the current design of the listed APMs.
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Description
To be an Advanced APM, an APM must meet the following three criteria:
1. Require participants to use certified electronic health record technology (CEHRT).
2. Provide payment for covered professional services based on quality measures comparable to those used in the quality performance category of the Merit-based Incentive Payment System (MIPS); and
3. Either: (1) be a Medical Home Model expanded under CMS Innovation Center authority; or (2) require participating APM Entities to bear more than a nominal amount of financial risk for monetary losses.
The dataset also identifies which APMs are “MIPS APMs. “Certain APMs include MIPS eligible clinicians as participants and hold their participants accountable for the cost and quality of care provided to Medicare beneficiaries. This type of APM is called a “MIPS APM,” and participants in MIPS APMs have MIPS special reporting requirements and receive special MIPS scoring under the “APM scoring standard.” Most Advanced APMs are also MIPS APMs so that if an eligible clinician participating in the Advanced APM does not meet the threshold of having sufficient payments or patients through an Advanced APM in order to become a Qualifying APM Participant (QP), the eligible clinician will be scored under MIPS according to the APM scoring standard.
About this Dataset
Data Info
Date Created | 2017-03-17 |
---|---|
Last Modified | 2021-06-28 |
Version | 2021-03-11 |
Update Frequency |
Irregular |
Temporal Coverage |
N/A |
Spatial Coverage |
United States |
Source | John Snow Labs; Centers for Medicare and Medicaid Services; |
Source License URL | |
Source License Requirements |
N/A |
Source Citation |
N/A |
Keywords | Alternative Payment Models, APMs, Quality Payment Program, Advanced APM Criteria, MIPS APMs |
Other Titles | APMs in the Quality Payment Program, CMS Alternative Payment Models |
Data Fields
Name | Description | Type | Constraints |
---|---|---|---|
APM | Alternative Payment Models is a payment approach that rewards providers for delivering high-quality and cost-efficient care. | string | - |
Is_Advanced_APM | Advanced Alternative Payment Models | boolean | - |
Is_APM_Scoring_Standards | Do Alternative Payment Models follow Scoring Standards | boolean | - |
Is_Medical_Home_Model | Medical Home Model | boolean | - |
Data Preview
APM | Is Advanced APM | Is APM Scoring Standards | Is Medical Home Model |
Accountable Health Communities (AHC) | False | False | False |
ACO Investment Model (AIM) | False | False | False |
Bundled Payments for Care Improvement Advanced Model (BPCI Advanced) | True | True | False |
Comprehensive Care for Joint Replacement (CJR) Payment Model (Track 1 - CEHRT) | True | False | False |
Comprehensive Care for Joint Replacement (CJR) Payment Model (Track 2 - non-CEHRT) | False | False | False |
Comprehensive ESRD Care (CEC) Model (LDO arrangement) | True | True | False |
Comprehensive ESRD Care (CEC) Model (non LDO arrangement onesided risk arrangement) | False | True | False |
Comprehensive ESRD Care (CEC) Model (non-LDO two-sided risk arrangement) | True | True | False |
Comprehensive Primary Care Plus (CPC+) Model | True | True | True |
Comprehensive Primary Care Plus (CPC+) Model 4 | True | True | True |