CMS is moving toward payment based on quality rather than quantity. Alternative payment models are at the forefront.
Alternative payment models, or APMs, reward health care providers for the quality of care they provide, rather than the volume of services they furnish to patients. APMs are one way that insurers are moving toward a value-based payment system and away from the traditional fee-for-service system — a priority of both the private sector and the federal government. APMs can apply to a specific clinical condition, a care episode, or a population.
The CMS APM effort continues to grow through the Center for Medicare and Medicaid Innovation Center, which tests various Medicare and Medicaid payment and service delivery models. Some of these APMs qualify as Advanced APMs under the Quality Payment Program, or QPP. Advanced APMs let clinicians earn more rewards in exchange for taking on risk related to delivery of high-quality, cost-efficient care. Alternatively, clinicians participating in QPP can choose to participate in the Merit-based Incentive Payment System, known as MIPS — a program addressed on a separate APTA webpage.
Apr 23, 2019 / Article
Mar 9, 2018 / Article
Feb 7, 2019 / Article
Jun 1, 2017 / Article
Feb 17, 2020 / Article
Additional Alternative Payment Models Content
Jan 8, 2020 / Review
Two studies of bundled care conclude that, at least for lower extremity joint replacement the models seem to be working.
Nov 5, 2018 / News
In "Moving Toward Quality Payment" in the November issue of PT in Motion, author Christine Lehmann breaks down the QPP into its 2 paths, particularly focusing on MIPs and its reporting requirements.
Nov 2, 2018 / News
Many PTs will face a new payment landscape beginning in January, now that CMS has finalized a rule that ends FLR and moves certain PTs into the Quality Payment Program.
Nov 1, 2018 / Feature
CMS has proposed changes to the 2019 physician fee schedule that would require eligible PTs to participate in Medicare's Quality Payment Program next year. To prepare, PTs must understand what's behind these efforts, what they need to do, and what may lie ahead.
Apr 1, 2018 / Column
It's time to prepare.
Mar 9, 2018 / Article
Thinking about joining a BPCI Advanced model? Consider these four steps.
Dec 1, 2017 / News
CMS issued a final rule that includes a scaled back knee and hip joint replacement bundled care model and cancellation of a plan to expand bundled care models to cardiac care and hip and femur fractures.
Mar 1, 2016 / Column
A new Medicare payment initiative offers patients and PTs a bundle of opportunities.