We’re quickly approaching 2019, the year when the Centers for Medicare & Medicaid Services – otherwise known as CMS – is set to begin its new reimbursement program (MACRA) based on a quality system that rewards clinicians with high quality scores and likewise penalizes those that achieve lower numbers. The goal is to ensure that Medicaid health providers are supplying their patients with top level care that includes a focus on quality medical practices, effective use of resources, implementation and use of EHR technology and a commitment to growth through clinical improvement activities.
There is a lot to understand, especially when it comes to how individual medical businesses need to be adapting. One of the most important decisions that providers need to be considering is which of the two payment models – Merit-based Incentive Payment System (MIPS) or Alternative Payment Models (APMs) – they will choose to work with.
There are differences between the two models and each practitioner should carefully weigh them against each other before deciding. To help inform and serve as a resource, here is a quick overview of one of the payment models – APMs.
A Payment Track with Greater Risk and Greater Reward
When choosing the APM path, health providers are accepting a greater financial risk based on the level of quality care they provide to Medicare patients. The most basic difference between APMs and MIPs is the amount of risk the provider is willing to accept and the amount of payment adjustment they receive in the value-based model. Because of the increased financial risk, providers who choose to go the APM route are rewarded with a 5% bonus, but only if they meet specific requirements.
There are 3 criteria that must be met in order to choose the APM track. These criteria include:
- The use of certified electronic health record technology, such as specialized EMR solutions.
- Have payment provided for covered professional medical services based on quality focused measures.
- Be a medical home model as detailed under the CMS innovation Center authority or require APM entities to take on more than a modest amount of financial risk for monetary loses.
It is also the providers responsibility to submit records and data that demonstrate their performance in value-based care. The data that’s submitted is scored, and the resulting number is used to indicate the payment incentive that will be received. The relationship between score and incentive is directly proportional with a higher score equally a payment bonus, and lower score resulting in a payment penalty.
Who Should Use an APM?
The general consensus is that larger medical operations are more well suited for APMs because they’re better equipped to handle the financial risk. However, what’s really needed to reap the benefits of APMs is to be prepared to invest in your Medicaid patients by providing them with top quality medical care while being adaptable to the operational changes and transformations that will take place as a result of meeting APM requirements.
If you’re a practitioner that’s committed to quality care and have a vision of how to adapt your medical business to meet growing patient demands, then APM might be the best choice for you. If this is the path you take, then connecting with an EMR service is essential. We have the EMR solutions that will help you achieve success with APMs. Contact Raintree Systems to learn more.