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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.
Recommended Content
Apr 23, 2019 / Article
Alternative payment models can seem hard to understand at first. We break down the basics.
Mar 9, 2018 / Article
CMS is ramping up its use of bundled care models, including limited use of a mandatory bundling program in some parts of the country.
Feb 7, 2019 / Article
Participating in a bundled care model can be a wise move, but only if you've taken the time to weigh the risks and benefits—and have an honest look at your practice.
Jun 1, 2017 / Article
Get up to speed on terminology, questions to ask yourself, and factors to consider before you develop a contract to participate in an APM.
Feb 17, 2020 / Article
CMS also offers APMs focused on Medicaid beneficiaries. Here are the programs PTs need to know about.
Additional Alternative Payment Models Content
Nov 30, 2022 / News
CMS has updated eligibility determinations based on the most recent reporting periods. Make sure you know where you stand.
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.'
Aug 7, 2020 / Review
The Quality Payment Program would see mostly minor changes and some shifts to respond to COVID-19-related challenges.
Aug 7, 2020 / News
CMS has released its MIPS scores for your 2019 performance, which could affect your payment in 2021.
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.
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.