>> J. P. Sharp: Introduction to advanced alternative
payment models.
I'm J. P. Sharp with CMMI, and I will
be leading you through this discussion.
So here we start with the definition of an alternative
payment model, and this is a very broad definition, and
this was set by the FCRA statute.
So when we say the word APM, it means this huge universe
of payment models that we use, and they're all tied
together by the fact that they're new approaches to
paying for care under Medicare, and they can
change the way that we reward quality and value,
and the CMS innovation Center produces a bunch of
these new payment models every year.
So when we say APM, it means any of these
four categories.
So that's CMS innovation Center models, other than
the healthcare innovation awards.
The shared savings program: any of those tracks under
the shared savings program, or those last two are any
other federal demonstrations required by law.
So, collectively, those are the world of APM.
So when we say APM, that's that starting place and,
then from there, we'll narrow things down for
certain types of APMs.
So this is the definition of an advanced alternative
payment model.
So these are where the incentives are in the
quality payment program.
So you start with that APM definition, and then you
have these subsets of those APMs or advanced APMs.
And they tend to have greater rewards, both in the
design of those types of APMs themselves.
They're greater risk, greater reward types of
payment arrangements.
But then what the quality payment program does is add
an additional bonus on top of all those APM-specific
rewards that you have, in order for taking on that
additional risk for being in an advanced APM.
And there at the bottom of the slide it's important to
note that what the quality payment program does is add
these extra incentives: the 5 percent
lump-sum incentive.
It does not change the actual terms of the advanced
APM itself.
So all of those terms and conditions that are inherent
to the APM, those remain the same.
The quality payment program does not change any of those
elements for how the new payment arrangements change
the way that Medicare pays for care.
Rather, it rewards just adoption of that new
payment arrangement.
And so this is a more explicit layout of the
rewards on the advanced APM track of the quality
payment program.
So for participating in an advanced APM, we will
identify those participating clinicians as qualifying APM
participants, or sometimes you'll see QP.
And so these QPs receive these specific rewards for
being in advanced APMs, in addition, as we said
earlier, to what the APM itself offers.
So, first, qualifying APM participants are excluded
from MIPS, so they won't have to do any of the
reporting requirements or receive any of those payment
adjustments associated with MIPS.
Instead, they'll receive a 5 percent lump-sum bonus, and
that lump-sum bonus is based on their Part B professional
service payments.
And that is limited in time, so the first lump-sum
payment will go out in 2019, and the last one will go out
in 2024.
So after that, the long-term incentive for being in an
advanced APM is in the fee schedule.
So these QPs will receive a higher fee schedule update,
starting in 2026, and so from there that compounds
upon itself so that QPs will get a higher and higher fee
schedule rate, relative to non-QPs overtime.
So those two lines will diverge from one another.
So every year that someone participates in an advanced
APM, they'll have an opportunity to receive this
higher fee schedule update.
And so this is a summary of the incentives that we
talked about.
So, side-by-side, starting from the left, if you're not
in an APM and you meet the criteria to be part of MIPS,
then you'll receive those MIPS adjustments.
But you won't receive anything in addition to that.
If you are in an APM that is not an advanced APM, you're
still subject to the MIPS reporting requirements and
payment adjustments, but you also get whatever is
inherent to those APMs.
So, as we said earlier, those APMs have their own
risk and reward structure.
So those do not change under the quality payment program.
And as we'll talk a little bit later, there are
specific ways that we score APM participants under MIPS,
so there're some certain favorable scoring elements
under MIPS as well.
On the far right side in an advanced APM you have the
opportunity to be excluded from MIPS: so no reporting
requirements, no MIPS payment adjustments, but you
get those APM-specific rewards.
And for advanced APMs, those tend to be a little bit
larger than those for non-advanced APMs.
And then, finally, those advanced APM participants
receive that 5 percent lump-sum bonus.
So that's an automatic payment that they will receive.
Thank you for viewing this presentation.
For more information please visit the quality payment
program portal at qbp.cms.gov.