An APM is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population.
Advanced APMs (AAPMs)
AAPMs are a subset of APMs, and let practices earn more for taking on some risk related to their patients’ outcomes. You may earn a 5% incentive payment by going further in improving patient care and taking on risk through an Advanced APM.
CMS APM Look-Up Tool
This is an interactive tool where many 2017 APM participants can look up their Qualifying APM Participant (QP) and MIPS APM status based on calculations from claims with dates of service between 1/1/17 and 8/31/17 for the third snapshot.
Starting this spring the 2018 MIPS Participation Status Tool will include APM information. CMS will be expanding this tool to include both Performance Year 2018 APM participation and predictive Qualifying APM Participant (QP) status.
The Methodology Fact Sheet can help you understand how we determined the QP Status based on eligible clinician performance.
What models are Advanced APMs?
In Performance Year 2018, the following models are Advanced APMs:
- UPDATED Bundled Payments for Care Improvement Advanced Model (BPCI Advanced)
- Comprehensive ESRD Care (CEC) – Two-Sided Risk
- Comprehensive Primary Care Plus (CPC+)
- UPDATED Medicare Accountable Care Organization (ACO) Track 1+ Model
- Next Generation ACO Model
- Shared Savings Program – Track 2
- Shared Savings Program – Track 3
- Oncology Care Model (OCM) – Two-Sided Risk
- Comprehensive Care for Joint Replacement (CJR) Payment Model (Track 1- CEHRT)
How do I join an Advanced APM?
- Learn about specific Advanced APMs and how to apply.
- Apply to an Advanced APM that fits your practice and is currently accepting applications.
- This website will be updated as new information is available.
What happens if I am in an Advanced APM?
Once you’re in an Advanced APM, you’ll earn the 5 percent incentive payment in 2020 for Advanced APM participation in Performance Year 2018 if:
- You receive 25 percent of your Medicare Part B payments through an Advanced APM or
- See 20 percent of your Medicare patients through an Advanced APM
You’ll need to send in the quality data required by your Advanced APM. Your model’s website will tell you how to send in your Advanced APM’s quality data.
If you leave the Advanced APM during Performance Year 2018, you should make sure you’ve seen enough patients or received enough payments through an Advanced APM to qualify for the 5 percent bonus. If you haven’t met these thresholds, you may need to submit MIPS data to avoid a downward payment adjustment.