post image

(Blog post #4 in a series covering 2016 anesthesia quality reporting)

As we’ve been covering in this space, providers pursuing Medicare reimbursements will have a choice of two paths to pursue for quality reporting starting in 2019. We covered the first option, the Merit-Based Incentive Payment System (MIPS), in a previous blog post. The following is an overview of Alternative Payment Models (APM), which places greater emphasis on quality and value.

The march toward quality and value

Alternative Payment Models, APM, are designed for eligible professionals with a significant portion of their payments coming from models that include risk of financial losses and use of quality measures certified EMRs. Eligible professionals who opt for APM will be exempt from MIPS payment adjustments, which have penalties of up to -4 percent in 2019 and grow to -9 percent in 2022. Instead, APM participants will be eligible for only positive adjustments, in bonuses of up to 5 percent of total Medicare payments for 2019-2024. Eligible professionals in APMs will also receive 0.75 percent in CF updates (fee increases) starting in 2026, versus only 0.25 percent EPs not in APMs.

These differences reflect HHS’s goal of transitioning from fee-for-service, which includes tying 50 percent of all Medicare fee-for-service payments to quality or value through APMs by 2018. But note: HHS also seeks to tie 90 percent of all Medicare fee-for-service payments to quality or value by 2018, including APMs and other means beyond APMs. Regardless of the path, the goal is to move toward quality and value.

What exactly is an APM?

What qualifies as an APM is still a work in progress. At this point, it includes:

  • Patient Centered Medical Homes, with or without risk of financial losses;
  • ACOs;
  • Models approved by the Center for Medicare and Medicaid Innovation (CMMI); and
  • Additional models that include providers other than primary care providers

CMS is open to considering all models that can add value, reduce cost and improve quality, and providers may submit programs for consideration. Going forward, we can expect to see many new models emerge, just as we saw with ACOs and others that continue to evolve. CMS appears to expect programs above and beyond what we have today in quality and value.

MIPS vs. APM: the differences at a glance

The following highlights the differences between MIPS and APM:

SGR Repeal Creaes Two Tracks for Providers






Keep in mind that you need not make a choice today between MIPS and APM. Going forward, the American Society of Anesthesiologists (ASA) will work with CMS to ensure that MIPS allows for successful participation by anesthesiology practices, and will continue to develop the Perioperative Surgical Home model, which includes fitting into the developing APM paradigms.

We will keep you updated in this space as MIPS and APM become further defined – and as always, we’ll do our part to help clients prepare for the coming shift in quality reporting, whichever option they eventually select.


Read earlier posts from our 2016 Anesthesia Quality Series:

Post #1 CMS Quality Reporting Changes: Market Myths vs What You Really Need to Know
Post #2 2016 Claims-Based Quality Reporting: Simpler Than You Might Think
Post #3 Looking forward to the Merit-Based Incentive Payment System (MIPS)

The information provided is intended to be a general summary and reflects information that is current at the time it was issued. This information is not intended to take place of either written law or regulations.


abeo Management Corporation (abeo) serves as a leading source of revenue cycle management and practice management with a specialization in anesthesia. The company leverages its people, processes, and software to serve independent practices, surgery centers, hospitals and healthcare systems with a scope of services that include billing, coding, transcription, practice management, and business consulting.

Join Our Newsletter