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CMS Predicts Advanced APM Participants’ Qualifying Status

The Centers for Medicare & Medicaid Services (CMS) has predicted qualifying alternative payment model participants (QPs) for the 2017 performance year of the Quality Payment Program (QPP). The QPP was established under the Medicare Access and Chip Reauthorization Act of 2015.

To determine QP status for eligible clinicians, CMS used the participation list for each alternative payment model (APM), as well as 2016 administrative claims, to:

  • identify eligible clinicians participating in advanced APMs;
  • identify attribution-eligible beneficiaries;
  • calculate payment amount threshold scores;
  • calculate patient count threshold scores; and
  • determine predictive QP or partial QP status for an APM entity group, based on the payment amount or patient count.

CMS’ analysis predicts that nearly 100 percent of clinicians who participated in Advanced APMs in 2016 would qualify for a 2019 incentive payment if they participate in 2017. Actual 2017 qualifying status will be based on claims from three points in time, or “snapshot” dates: March 31, June 30, and Aug. 31.

Visit the association’s QPP resource page for new and updated information on the program and its provisions.

Contact Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Maryellen Guinan is a senior policy analyst at America's Essential Hospitals.