BC Advantage - 2018 Issue 11
Thanksgiving Leftovers Advanced APMs and the 2019 QPP Final Rule
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Article Overview
This piece explains the 2019 QPP final rule as it relates to Advanced Alternative Payment Models, especially the ESRD-focused ESCO program used by many nephrologists. It provides a high-level review of Advanced APM requirements, changes affecting electronic health record use, quality-measure expectations, and financial-risk standards, along with the broader implications for qualifying participants and Medicare participation. The article is intended for clinicians, nephrology practices, and healthcare administrators following Medicare payment policy and value-based care programs.
Why This Topic Matters
The article helps nephrology stakeholders understand whether their ESCO participation is affected by the 2019 rule and what aspects of the Advanced APM framework remain stable or change over time.
Article Sections
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ESCOs
Introduces the ESCO program within the Advanced APM landscape and discusses its importance for nephrology participants. The section also frames how participation relates to qualifying participant status and Medicare payment implications.
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AAPM requirements
Summarizes the general criteria used to define an Advanced APM and sets up the discussion of which parts of the framework are affected by the 2019 final rule.
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CEHRT
Discusses the electronic health record technology requirement for Advanced APM participation and notes the direction of the 2019 policy update.
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Quality
Addresses quality-measure expectations for Advanced APMs and references the ESCO program’s annual quality-measure updates.
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Downside risk
Reviews the financial-risk component of Advanced APMs and the stability of the nominal risk standard through future performance years.
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Less is more
Concludes with a summary of the overall effect of the final rule on the ESCO program and the broader Advanced APM framework.
What You Will Learn
- How the 2019 QPP final rule affects Advanced APM participation
- What general requirements define an Advanced APM
- Which policy areas are discussed for ESCOs
- How the article frames changes to electronic health record, quality, and risk standards
- Why the ESCO program remains important to nephrology stakeholders
Who Should Read This
- Nephrologists
- Nephrology practice administrators
- Medical coders and reimbursement staff
- Healthcare compliance and payment policy professionals
- Clinicians participating in Medicare value-based programs
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