Exploring MACRA

Female Physician

MIPS APM Overview

MIPS APMs are a hybrid between the MIPS payment track and the Advanced APM payment track. Physicians participating in these APMs will be assessed based on the four MIPS performance categories and subject to payment adjustments under MIPS. However, physicians will be scored using a special APM scoring standard wherein different weights are assigned to the performance categories that are more favorable for participants of these APMs when calculating the composite score.

Eligibility

MIPS APMs are those APMs that meet the following criteria:

  1. APM Entities participate in the APM under an agreement with CMS or through a law or regulation;
  2. The APM is designed such that APM Entities participating in the APM include at least one MIPS eligible clinician on a Participation List;
  3. The APM bases payment on cost/utilization and quality measures; and
  4. The APM is not either of the following:
    1. New APMs. An APM for which the first performance year begins after the first day of the MIPS performance period for the year.
    2. APM in final year of operation for which the APM scoring standard is impracticable. An APM in the final year of operation for which CMS determines, within 60 days after the beginning of the MIPS performance period for the year, that it is impracticable for APM Entity groups to report to MIPS using the APM scoring standard.

Physicians who participate in an Advanced APM, but do not qualify to be either a Qualifying APM Participant (QP) or a Partial Qualifying APM Participant (PQ), or qualify to be a PQ and choose to participate in MIPS, fall under MIPS APMs.  Physicians who participate in an APM that is not considered an Advanced APM, for example, MSSP Track 1 ACOs, also fall under MIPS APMs.

For more information on Qualifying APM Participant (QP) and Partial Qualifying APM Participant (PQ) click here.

CMS’ APM List shows which APMs are MIPS APMs:

APM Scoring Standard

Physicians in a MIPS APM will be scored using a special APM scoring standard wherein different weights are assigned to the performance categories that are more favorable for participants of these APMs when calculating the composite score.  These weights are as follows:

  • Quality – 50%
  • Improvement Activities – 20%
  • Advancing Care Information – 30%
  • Cost – 0%

CMS will apply the APM scoring standard if the physician is participating in an APM Entity in the MIPS APM on at least one of four “snapshot” dates: March 31, June 30, August 31, or December 31. If the physician participates in a MIPS APM but is not on the APM Participation List on one of the four snapshot dates, the physician will not be scored using the APM scoring standard and should instead report according to the generally applicable MIPS requirements, either as an individual or as a group.

For more information on general MIPS requirements Click here.

Payment

Physicians participating in MIPS APMs are not eligible for the 5 percent lump-sum Advanced APM incentive payment. However, they may qualify for positive MIPS payment adjustments and exceptional performance bonus, based on the APM entity’s final score.