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Alternative Payment Models

What are Alternative Payment Models (APMs)?

APMs use bundles to link the payment of unconnected services for an episode of care or condition. Bundling services that were previously billed separately is meant to reduce unnecessary spending and improve quality. Physicians who provide a certain percent of their patient care in the APMs will be exempt from many MIPS requirements and will be offered additional incentives. For example:

  • From 2019-2024, pay some participating health care providers a lump-sum incentive payment.
  • Increased transparency of physician-focused payment models.
  • Starting in 2026, offers some participating health care providers higher annual payments. 

Accountable Care Organizations (ACOs), Patient Centered Medical Homes, and bundled payment models are some examples of APMs. CMS currently has a number of APMs that are being evaluated through demonstration projects, but the first MACRA changes to physician payment are operational now. CMS now has as a goal, in general, having 30% of traditional Medicare payments tied to performance by the end of 2016, and 50% of these payments tied to APMs or some type of performance/value-based reimbursement by the end of 2018. Reimbursements under the new MACRA policy depends heavily on system-based and patient-based outcome measures. 

What is AUGS doing to facilitate the participation in APMs?

AUGS has formed a Payment Reform Committee that will focus part of their work on the development of advanced alternative payment models so that there will be opportunities for urogynecologists to participate in this quality payment program pathway. The soonest that could be available would be for 2018 reporting.