MIPS versus Advanced APMs – highlights of the different models, and what it could mean for your practice
The Quality Payment Plan (QPP) has two paths that you could take for reporting for your reimbursements from CMS – MIPS, which has a few options under that path; and the Advanced APMs. Reporting is important for all community practices as reimbursements can affect your payments positively, negatively, or neutrally.
For MIPS, you can report using the traditional MIPS reporting, through an MVP (MIPS Value Pathway, which is expected to eventually replace traditional MIPS) or with the MIPS APMs (Alternative Payment Model).
What are the Alternative Payment Models?
This is a value-based payment approach which offers extra incentives to provide patients with high-quality, cost-effective care. The approach can apply to care episodes, clinical conditions, or patient populations. All Advanced APMs are considered MIPS APMs, but not all MIPS APMs are Advanced APMs.
When you participate in an APM, you agree to be paid in the terms of that specific model. Advanced APMs have more stringent requirements where at least 75% of the practices use Certified EHR technology and participants will bear a more significant amount of financial risk (more than a MIPS APM), but with that risk comes the potential for more pay-out.
Advanced APMs can be considered for QP (Qualifying APM Participant) status by meeting certain thresholds between January 1 – August 31. In 2023 the APM Incentive payment is 3.5%; in future years, the incentive is an increased conversion factor on the PFS.
Our team notes that if your practice is participating in the EOM (Enhancing Oncology Model) this year, you will likely not make QP status as the EOM program started in July. Those practices should plan on reporting under the Advanced APM.
If you are participating in an APM and not receiving full or partial QP status, you are eligible to report in MIPS – as an individual, group, MVP, MIPS APM entity, APM Performance Pathway or a Virtual Group. CMS takes the highest score if you report more than one way.
The acronyms are confusing. Reporting as a small practice may seem overwhelming as resources are limited. But understanding that if you are not reporting, it can mean a significant negative adjustment to your bottom line for non-participation.
Our MIPS consulting team is ready to answer questions or help with your submission – find out what they can do to ready your practice for the future of reimbursements under value-based care programs. Contact them at: QREG@intrinsiq.com