As the Centers for Medicare and Medicaid Services (CMS) moves toward a value-based payment plan, many independent physicians are growing concerned about their practices’ financial risks. Under the Merit-based Incentive Payment System (MIPS), providers are penalized for poor performance scores. With the shift towards value-based care, a portion of an independent physician practice’s Medicare payments are at risk and this share will grow over time.
However, another option, known as the Advanced Alternative Payment Model (APM), may be available. The third track, the MIPS-APM track, is described in an article in Modern Healthcare, as being “available for physicians participating in Track 1 of the Medicare Shared Savings Program,” and as one that “doesn’t punish physicians for low scores in MACRA performance categories.” This model is only available, though, to those physicians participating in an Accountable Care Organization (ACO).
ACOs are formed by physicians who are concerned with providing coordinated care to their Medicare patients. Modern Healthcare further explains that “establishing an ACO requires healthcare organizations to build data analytics tools, enhance information technology and hire care coordinators and additional staff to oversee the venture. “
CMS lists the following three criteria to determine whether a practice qualifies as an Advanced APM:
1) Practice uses certified EHR technology.
2) Practice employs quality measures similar to those used in the MIPS quality performance category to provide payments
3) Practice takes on an increased financial risk for monetary losses, in forms such as reduced rates or withheld payments.
The MIPS-APM track helps transition the independent physician into value-based care, particularly those who are concerned about the financial ramifications of the new reimbursement strategy. One of the MIPS-APM’s goals, according to CMS, is to “reduce eligible clinician reporting burden,” which will also, in turn, help reduce the financial burden on the independent provider.