Advanced Alternative Payment Models. Part I: Understanding the Medicare Shared Savings Program.

With CMS establishing preliminary definitions for fully qualifying Advanced Alternative Payment Models (APMs) in May 2016, it has become of interest to many care providers accepting Medicare and Medicaid payments to understand the nature of these entities if they wish to eventually participate in one of the current or future payment models. Changes under the Medicare Access and CHIP Reauthorization Act of 2015 specifically identify subsets of APMs that allow providers to avoid possible negative adjustments for poor relative performance compared with their respective peer groups through the Merit-Based Incentive Payment System beginning in 2017. This article reviews the nature of one of the fully qualifying Advanced APMs, the Medicare Shared Savings Program, and its risk/benefit sharing principles. Due to the lack of specialty-specific elements, this program acts as a very broad APM for practices and organizations seeking participation in either a simple or Advanced APM for the 2018 reporting period and beyond.

Advanced Alternative Payment Models Part II: Understanding the Next Generation Accountable Care Organization Model.

With CMS establishing preliminary definitions for fully qualifying Advanced Alternative Payment Models (APMs) in May of 2016, it has become crucial to many care providers accepting Medicare and Medicaid payments to understand the nature of these entities if they wish to eventually participate in one of the current or future payment models. Changes under the Medicare Access and CHIP Reauthorization Act of 2015 specifically identify subsets of APMs that allow providers to avoid possible negative adjustments for poor relative performance compared with their respective peer groups through the Merit-Based Incentive Payment System beginning in 2017. This article reviews the nature of one of the fully qualifying Advanced APMs, the Next Generation Accountable Care Organization (ACO) Model, and its risk-benefit sharing principles based on prior experience with the Medicare Shared Savings Program and other previous ACO models. This model represents a more sophisticated option for organizations with significant ACO experience seeking an Advanced APM for the 2018 reporting reriod and beyond.

Modified Stage 2 and Stage 3 Meaningful Use for Eligible Providers: Performance Metrics, Reporting Period Lengths, and Hardship Exemptions.

In October 2015, the Centers for Medicare & Medicaid Services released its final rule on the new guidelines for alterations to the long-standing EHR Incentive Program. These Modified Stage 2 and upcoming Stage 3 Meaningful Use Rules were developed in response to provider and organizational feedback during the last few years. This article provides a comprehensive overview for the new rules as they relate to Medicare and Medicaid Eligible Providers. Reporting deadlines for previous calendar year compliance and the basic criteria for automatic provider hardship exemptions to avoid reimbursement penalties also are discussed.

Creating Loose Alternative Payment Model Guiding Principles: A Brief Overview.

Alternative payment models (APMs) represent an unprecedented opportunity. for providers to have direct input into the terms of their own reimbursements for services provided. Understanding the rough boundaries of what comprises an APM is critical for those wishing to pursue possible involvement in APM devel- opment. This article attempts to provide structure to the plethora of CMS and other sources describing the principles guiding APM creation. Most importantly, as it is becoming increasingly apparent that APMs are a preferred method for. CMS to pay providers, organizations capable of leveraging stakeholder input and identifying methods to help meet the CMS Triple Aim via novel APMs will undoubtedly find themselves in much more powerful bargaining positions than those who simply adopt cookie-cutter approaches or, worse, fail to meet CMS goals and receive negative reimbursement adjustments through the Merit-based Incentive Payment System (MIPS) in 2019.

A Sampling of Alternative Payment Models.

Understanding the current selection of CMS-approved alternative payment models is critical for providers in the current healthcare policy climate who wish to pursue alternatives to traditional reimbursement schemes. This has become a topic of increasing interest with the recent passage of the Medicare Access and CHIP Reauthorization Act of 2015, as traditional fee-for-service payments will be altered-either positively or negatively-by criteria defined under the Merit-Based Incentive Payment System (MIPS). This article offers a framework for current and proposed models being implemented or investigated by the CMS. Further exploration of the topic can be carried out through supplementary or primary sources to determine best fits for specific practice environments.