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Advanced Alternative Payment Model Pros And Cons

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Advanced Alternative Payment Model (APM) The article I chose to research is titled “MACRA Strategies for 2017: Advantages and Disadvantages of Four Options”. MACRA is the Medicare Access and CHIP Reauthorization Act; it was signed into law on April 16, 2015 by president Obama. MACRA replaced the Medicare reimbursement schedule with a pay-for-performance program which focuses on quality, value, and accountability. This act should incentivize providers to give better care instead of more service because they will be rewarded for it. On the other hand, providers may see negative payment adjustments if they aren’t careful. This article discusses the pros and cons of each of the four options that the Centers for Medicare and Medicaid Services (CMS) …show more content…

The pros that were discussed in relation to participating in an APM include: • “Five percent bonus payment based on prior Medicare payments • Medicare will not calculate a Composite Performance Score for providers for QPs, so there will not be public reporting of a MIPS score on the Performance Score on the CMS Physician Compare website • Potential increased earnings associated with high-performance in a shared-risk advanced APM • Establishing a new model for patient care in a practice designed to improve the quality of care while reducing cost • Eligible clinicians who engage with an Advanced APM but do not meet the minimum payment or volume thresholds have the ‘option’ of participating in the MIPS program during that performance year. In other words, if the clinician feels they may be eligible for a positive payment adjustment under the MIPS program they have the option of participating, but is not mandatory.” (Marron-Stearns, …show more content…

I believe that there needs to be complete transparency when it comes to these scores. Not having a score listed could unintentionally raise suspicion with prospective clients. The cons that were discussed in relation to participating in an APM include: • “Limited availability of Advanced APMs in 2017. CMS estimates that approximately 70,000 to 120,000 eligible clinicians will engage in Advanced APMs in 2017. Approximately 600,000 eligible clinicians will be required to submit MIPS data. (These are eligible clinicians that: (1) are not QPs participating in Advanced APMs, (2) exceeded the low volume threshold, and (3) have been enrolled as Medicare physicians for more than one year.) • Minimum payment and volume thresholds are (a) 25 percent of Medicare Part B payments, or (b) 20 percent patient volume associated with an Advanced

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