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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