Finding the Right Alternative Payment Model

Are you confused about the complexities of Alternative Payment Models? Do you know how to determine which APM is a “good” one and will be effective in not only achieving savings but also improving quality?

According to the Center for Healthcare Quality & Payment Reform’s paper: “The Problems with Medicare’s Alternative Payment Models and How to Fix them”, an APM must correct the current problems with fee for service while preserving its strengths. The paper outlines eight criteria to determine if an APM will be successful.

Does the APM Correct the Problems with Fee-For-Service (FFS)?

1. Does the APM pay for the high-value services needed to improve patient care?
2. Does the APM align payment amounts with the cost of delivering high-quality care?
3. Does the APM assure each patient they will receive appropriate, high-quality care?
4. Does the APM make the cost of diagnosing or treating a health condition more predictable and comparable?

Does the APM Preserve the Strengths of FFS?

1. Will a provider only be paid under the APM if a patient receives care?
2. Are payments under the APM higher for patients who need more services?
3. Is the provider’s payment under the APM based on things the provider can control?
4. Will providers know how much they will be paid under the APM before delivering services?

For rationale behind the questions and to read the paper in its entirety click here.

While the paper raises many questions, there are tools and resources available to help you navigate different options. The ACP Quality Payment Advisor^®, a free ACP member benefit, will help you determine the best options for you and your practice.  It will help you understand QPP and choose the right pathway by asking a series of questions based on an algorithm. Each question provides education and leads to a report and resources to help you implement QPP within your practice.

The Quality Payment Program portal on the CMS website provides educational materials, tools, and resources. For more information go to qpp.cms.gov.  

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