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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.

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Additional Alternative Payment Models Content

Your MIPS Status May Have Changed: Here's How to Find Out

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CMS has updated eligibility determinations based on the most recent reporting periods. Make sure you know where you stand.

Study: Time for Better Risk Adjustment in THA, TKA Bundled Care Models

May 25, 2021 / Review

Researchers put price tags on comorbidities associated with higher TJA costs and see risk adjustment as a way to counter 'cherry picking.'

CMS: Minimal Changes to MIPS, Advanced Alternative Payment Models for 2021

Aug 7, 2020 / Review

The Quality Payment Program would see mostly minor changes and some shifts to respond to COVID-19-related challenges.

MIPS Performance Scores Now Available

Aug 7, 2020 / News

CMS has released its MIPS scores for your 2019 performance, which could affect your payment in 2021.

APTA's Physical Therapy Outcomes Registry Again Receives QCDR Designation f...

Jan 21, 2020 / News

APTA's Physical Therapy Outcomes Registry has been approved for the fourth year in a row by CMS as a qualified clinical data registry.

Separate Studies, Similar Conclusions: Bundling for Knee, Hip Replacement S...

Jan 8, 2020 / Review

Two studies of bundled care conclude that, at least for lower extremity joint replacement the models seem to be working.

From PT in Motion Magazine: A Primer on Major Medicare Payment Changes

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.

Physician Fee Schedule and QPP: A New Payment World Awaits PTs in 2019

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.

Moving Toward Quality Payment

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.

MIPS and APMs: Where We Are Now

Apr 1, 2018 / Column

It's time to prepare.