decisionhealth Newsletters, Coder Pink Sheets - 2016 Issue 6 (June)
Quality reporting: Watch out if you’re in a bundled service plan; most don’t fit the APM mold
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Article Overview
This article explains CMS’s proposed approach to bundled payment models and their relationship to MIPS participation. It is relevant for clinicians, physician groups, hospitals, and compliance or quality-reporting teams trying to understand whether a bundled service arrangement is treated as an APM or advanced APM under the proposal. The discussion focuses on the general framework CMS uses, examples of model types, and the implications for participation status and quality reporting.
Why This Topic Matters
Organizations involved in bundled payment programs need to know whether those arrangements affect MIPS obligations and whether they meet APM or advanced APM criteria. The article helps readers determine which kinds of models are included or excluded under CMS’s proposed framework.
What You Will Learn
- How CMS distinguishes bundled payment arrangements from qualifying APMs under the proposed rule
- Which broad model types CMS identifies as not meeting the APM criteria
- What general features CMS associates with advanced APM status
- Why program design matters in CMS’s proposed framework for quality reporting
Who Should Read This
- Clinicians
- Physician groups
- Hospitals
- Quality reporting teams
- Compliance staff
- Revenue cycle professionals
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