MGMA16: 4 questions to decide if an AAPM is right for you


SAN FRANCISCO--For many physician practices, a major question right now is whether they should participate in an advanced alternative payment model (AAPM)--one of the two Medicare payment options under MACRA.

While the government hopes the Medicare Access and CHIP Reauthorization Act will push more clinicians toward alternative payment models, many physicians wonder whether participation in an AAPM is right for their practice, said Anders Gilberg, senior vice president for government affairs at the Medical Group Management Association.

The Centers for Medicare & Medicaid Services, which rolled out the final rule implementing MACRA, expects only 10 percent of clinicians covered under the new requirements will be in an AAPM in 2017. But that number is expected to grow to 25 percent by 2018, as the government expands the list of AAPMs.

MGMA conference logo

Practices should explore both options, Gilberg advised this week during the MGMA’s annual conference in San Francisco. An MGMA poll taken during the conference found nearly 60 percent of attendees indicated they would participate in the new Medicare physician payment programs in 2017. Most (53.19 percent) will participate through the Merit-based Payment Incentive System (MIPS) and far fewer (6.95 percent) will participate through the AAPMs.

Practices that participate in a qualifying AAPM will:

  • Be exempt from MIPS requirements.
  • Be eligible for a 5 percent annual lump sum bonus payment through 2024.
  • Be eligible for a 0.5 percent higher fee schedule update from 2026 onward.

According to Gilberg, some of the questions practices should consider as they decide whether an AAPM is right for them, including the following:

  • Will the practice fare better being evaluated collectively as part of an APM or under MIPS?
  • Are there benefits of an APM model beyond the lump sum bonus?
  • What are the startup and ongoing costs that go along with participating in an APM?
  • Is it better to participate in MIPS in 2017 and wait for the government to include additional APMs in 2018 and beyond?