What is an AAPM? Who can participate? How do you qualify? We have the answers you need in this slide-share. Learn more here http://www.insight-txcin.org/post/understanding-the-advanced-alternative-payment-model

1. WHAT
IS THE
AAPM?
BY TXCIN

2. The Medicare Access and CHIP
Reauthorization Act (MACRA) of 2015 began a
reformation of modern healthcare from fee-
for-service (FFS) to value-based care. Among
other policies, MACRA legislation repealed the
Medicare Part B Sustainable Growth Rate
(SGR) reimbursement methodology, and it
initialized a phasing out of the Medicare
Physician Fee Schedule (PFS). In addition,
MACRA legislation introduced the Quality
Payment Program (QPP), a new, more
streamlined performance-based payment
system consisting of two scoring and
reimbursement frameworks:
The Merit-based Incentive Payment
System (MIPS) [and]
The Advanced Alternative Payment Model
(AAPM) system.

3. Both frameworks are
regulatory “environments”
that establish
performance
measurements used to
score clinicians to
determine payment
adjustments and bonuses.

4. Whereas the Merit-based
Incentive Payment System
is the default scoring and
performance pathway in
the QPP, the Advanced
Alternative Payment
Model (AAPM) is the most
advanced scoring and
performance pathway.

5. what is
the
AAPM?
The goal of the Quality Payment
Program’s Medicare reform is to
gradually move clinicians from solely
practicing under MIPS, to practicing
under an Alternative Payment Model
(APM), to ultimately practicing under
the Advanced Alternative Payment
Model (AAPM). An APM is an “in-
between” payment structure that
incorporates a modified MIPS and
APM Scoring Standard. Advanced
APMs are often referred to as “subsets”
of APMs; however, this is misleading,
because Advanced APMs are an
“advanced” form of the Alternative
Payment Model, a higher level of APM
participation, exempt from MIPS.

6. UNDERSTANDING
THE ADVANCED
ALTERNATIVE
PAYMENT MODEL
Each year the Centers for Medicare and Medicaid Services
(CMS) invites clinicians and organizations to propose new
payment models for consideration as Advanced APMs.
Advanced APM entity groups coordinate and agree with
CMS to adhere to higher levels of healthcare criteria;
specifically, Advanced APMs take on a greater amount of
“downside risk,” or “two-sided risk.” Because Advanced
APMs manage greater financial risk, CMS exempts them
from the MIPS reporting system and any payment
adjustments, and CMS rewards them with a 5% lump sum
performance bonus.

7. To qualify as an Advanced
APM (AAPM), the entity
group must meet the
following CMS eligibility
requirements:

8. A
A
P
Pay for professional services that record
Quality Measures comparable to those
used in the quality performance
category of MIPS.
Require at least 50% of participants to
use Certified Electronic Health Record
Technology (CEHRT).
Assume more than a “nominal amount”
of financial risk for monetary losses or be
a Medical Home Model expanded under
the Center for Medicare and Medicaid
Innovation (CMMI) authority.M

9. Each year CMS provides a
list of care models that
qualify as Advanced
APMs.
For 2018, the following
models are considered
Advanced APMs:

10. A
A
P
Comprehensive ESRD Care Model (LDO
and Non-LDO arrangements)
Comprehensive Primary Care Plus (CPC+)
Medicare Shared Savings Program
(MSSP ACOs Track 2 and Track 3)
Next Generation ACO Model
Oncology Care Model (only two-sided
risk arrangements)
Comprehensive Care for Joint
Replacement (CJR) Payment Model
(Track 1 – CEHRT)
Vermont Medicare ACO Initiative (as part
of the Vermont All-Payer ACO Model)
M

11. A
A
P
Cardiac Rehabilitation (CR) Incentive
Payment Model
Acute Myocardial Infarction (AMI) Model
(Track 1 – CEHRT)
Coronary Artery Bypass Graft (CABG)
Model (Track 1 – CEHRT)
Medicare-Medicaid Accountable Care
Organization Model (MMACO Tracks 2
and 3)
Advancing Care Coordination through
Episode Payment Models Tracks 1 and 2
Medicare ACO Track 1+
Surgical Hip/Femur Fracture Treatment
(SHFFT) Model (Track 1 – CEHRT)
M

12. At the time of this article, there were
approximately 49 qualifying
Alternative Payment Model (APM)
entity groups listed in the Quality
Payment Program (QPP) and only 14
of those meet the requirements as an
Advanced APM entity group.
http://www.insight-txcin.org/post/understanding-the-
advanced-alternative-payment-model

13. Want
More?
http://www.insight-
txcin.org/post/understandin
g-the-advanced-alternative-
payment-model

14. ABOUT
TXCIN
North Texas Clinically
Integrated Network, Inc. (dba
TXCIN) is a non-profit ACO
that began in late 2014. A
small group of independent
physicians aligned to initiate
clinical integration and value-
based contracting. Partnering
with RevelationMD and its
state-of-the art information
platform, TXCIN has become
the largest independent
network of physicians in North
Texas.