APM in Quality Payment Program

$79 / year

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.

Complexity

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.

Date Created

2017-03-17

Last Modified

2018-02-05

Version

2018-02-05

Update Frequency

Irregular

Temporal Coverage

N/A

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare and Medicaid Services

Source License URL

John Snow Labs Standard License

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

Name Description Type Constraints
APMAlternative Payment Models is a payment approach that rewards providers for delivering high-quality and cost-efficient care.string-
Is_APM_Scoring_StandardsDo Alternative Payment Models follow Scoring Standardsboolean-
Is_Medical_Home_ModelMedical Home Modelboolean-
Is_Use_Of_CEHERT_CriterionUse of Certified Electronic Health Record Technology Criteriaboolean-
Is_Quality_Measure_CriterionQuality Measure Criteriaboolean-
Is_Financial_Risk_CriterionFinancial Risk Criteriaboolean-
Is_Advanced_APMAdvanced Alternative Payment Modelsboolean-
APMIs_APM_Scoring_StandardsIs_Medical_Home_ModelIs_Use_Of_CEHERT_CriterionIs_Quality_Measure_CriterionIs_Financial_Risk_CriterionIs_Advanced_APM
State Innovation Models — Round 1 (SIM 2)
State Innovation Models — Round 2 (SIM 2)
Medicare-Medicaid Financial Alignment Initiative
Next Generation ACO Modeltruefalsetruetruetruetrue
ACO Investment Model (AIM)falsefalsefalsefalsefalsefalse
Pennsylvania Rural Health Modelfalsefalsetruefalsetruefalse
Maryland All-Payer Hospital Modelfalsefalsefalsefalsetruefalse
Medicare Care Choices Model (MCCM)falsefalsefalsefalsefalsefalse
Accountable Health Communities (AHC)falsefalsefalsefalsefalsefalse
Comprehensive Primary Care Plus (CPC+) Modeltruetruetruetruetruetrue
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