MIPS vs. APM track in 2017: Where will you fall under MACRA?

This post was updated based on the Quality Payment Program final rule on October 20, 2016.

The Centers for Medicare and Medicaid Services (CMS) has included two tracks as part of the Quality Payment Program under MACRA, starting in 2017. These include the Merit-Based Incentive Payment Program (MIPS) track and the Advanced Alternative Payment Model (Advanced APM) track. MIPS is a payment program that applies payment adjustments to Medicare Part B payments based on an eligible clinician’s or group’s performance across four performance categories. The Advanced APM track exempts clinicians and groups from MIPS and rewards them with a 5% upward payment adjustment for participating in select payment models that include financial risk.

For Medicare physicians and groups that know they will be impacted by these new requirements, it is important to remember that planning for the Quality Payment Program is more nuanced than simply ‘selecting a track.’ For example, in order to qualify for MIPS exemption as part of the Advanced APM track, eligible clinicians and groups must meet thresholds for minimum patients or payments in an eligible Advanced APM during the performance period. This means that basic participation in an Advanced APM may not be enough, and participants cannot predict whether they they will meet the thresholds at the beginning of the year. In general, the distinctions between the two tracks are less clear than some descriptions of the Quality Payment Program suggest, which means there could be physicians and groups who believe they are meeting requirements when they really aren’t.

To help make understanding the two Quality Payment Program tracks a bit easier, Able Health has prepared a flowchart to help physicians and medical groups to determine exactly which track may be the most appropriate to prepare for in 2017. You can view the chart below or download and print it as a PDF here.

Click here or on the image below to view an enlarged PDF version.

Quality Payment Program Flow Chart

Download and print this reference sheet as a PDF


Further reading:
Should I just do the minimum? 3 Reasons clinicians and groups are going all out in MIPS this year
MIPS Advancing Care Information: Frequently Asked Questions

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