>>J.P. Sharp: What is the APM Scoring Standard?
I'm J.P. Sharp with CMMI, and I will
be leading you through this discussion.
So what are MIPS APMS?
So, the APM scoring standard in general is a way to
bridge the gap between APM participants, and the
MIPS program.
So these two tracks overlap a little bit where if you're
not in an advanced APM, and excluded from MIPS, you'll
still be subject to the MIPS reporting requirements, and
payment adjustments.
But you're also doing activities under the APMs,
and so this APM scoring standard is designed to make
that a seamless transition, and reduce the burden so
that we take account of the activities that you're
already doing for the purposes of the APM, and
translating those over to MIPS so that you don't have
duplicative or conflictive reporting across the
two programs.
And so MIPS APMs are a type of APM, so again it's a
subset of APM, kind of like advanced APMs, but it's a
little broader than advanced APMs so we'll capture more
types of APMS in that, but generally they hold people
accountable for the quality and cost of care, so we want
to take account of that, and use that for
purposes of MIPS.
So the general premise of it is that all of the eligible
clinicians in an APM entity, again that Accountable Care
Organization, group practice, hospital,
depending on the type of APM we're talking about.
So all of those eligible clinicians will be assessed
collectively, and they will receive the same MIPS score,
and payment adjustment for that particular year.
So when we say MIPS APM we're talking about the
specific type of APM, and so it's really one that checks
these three boxes, and they're pretty broad.
So they have an agreement with CMS, there are one or
more MIPS eligible clinicians on a participant
list, so we can identify clinicians who are subject
to MIPS, and then the last one is that the APM bases
payment on cost and quality.
So that's assuring us that they're being assessed for
the things that MIPS assesses, but they're just
doing it through the APM instead.
So this will look familiar if you saw the advanced APM
in the QP determination portion.
So this is how we determine who is part of an APM for
purposes of this APM scoring standard under MIPS.
So we look at this using three snapshot dates, and by
the end of it we end up with a group -- a list of
clinicians who are part of one group of an APM entity,
and they'll all receive the same MIPS score, and
payment adjustments.
So we do that by looking at these three points in time
that our CMS maintain the lists.
And if you're in the list at any one of these points
you'll be considered part of that group.
So on March 31st we'll look in our lists, and everybody
in that list for a particular group is
considered part of that group, and that can't be
taken away from them.
And then on June 30th we'll do that again.
So any additional people would also be included in
that group, but everybody on March 31st is still
included there.
And then we'll do that one more time.
So August 31st, any people who have subsequently joined
after those previous snapshot dates would then be
considered in that group.
So it's additive over time, and then by August 31st
we'll have the full group.
Everybody there will then be considered one unit for
purposes of the APM scoring standard.
So then these are the APMs that we consider MIPS APMs.
And so these are the ones where you get a special APM
scoring standard by participating in these, and
so you'll see the CEC model, the CPC-plus model, the
Shared Savings Program tracks, the Next-Generation
ACO model, and the Oncology Care model.
The difference here that you'll notice if you saw the
advanced APM groups is that there's a lot of overlap, so
there are APMs that can be both advanced APMs
and MIPS APMs.
However, for the advanced APMs most of those
participants will meet those QP thresholds and they'll be
excluded from MIPS.
However, they'll be -- as a backup -- if they don't meet
those thresholds, they'll fall back into this APM
scoring standard so there won't be a lot of additional
work for them to do, it will be ready for them to
participate in MIPS.
And then for these other tracks that may not have a
two-sided financial risk -- meaning that they don't have
those elements of financial risks such that they're
responsible for repaying, or reducing their payment
rates, or having payments withheld, but they still
account for costs so that there can be shared
savings elements.
So they're being assessed for their cost of care.
So that's why you'll see things like the Shared
Savings Program track one, or the one-sided
arrangements in the CEC model, or the OCM model.
So this is the list here, and it's at QPP.CMS.gov, so
I recommend you go there to see the comprehensive list
of APMs, and which ones will be scored under the APM
scoring standard, and which ones are advanced APMs as well.
Thank you for viewing this presentation.
For more information, please visit the Quality Payment
Program portal at QPP.CMS.gov.