Orthopedic Payment Models Guide

A Guide to Orthopedic Payment Models: MIPS, APMs, Bundles, and More

Alternative Payment Models (APMs)

Alternative Payment Models (APMs) started in 2019. Since that time, APMs have become increasingly popular in value-based care. Physicians must meet a threshold of Medicare payments or reach a percentage of patients covered by Medicare to participate in the APMs. Under that threshold, the physicians still are required to report within the Merit-Based Incentive Payment System (MIPS) program.

There are three (3) basic requirements to qualify as an Alternative Payment Model:
1. Minimum of 75% of physicians in the group utilize Certified Electronic Health Record Technology to document and communicate clinical information
2. Payment is based on quality measures within the MIPS program with at least one (1) being an outcomes measure
3. Payment models also require at least some level of risk for the provider when reimbursements are above a benchmark level
Benefits of participation in an Alternative Payment Model for physicians include:
• 5% incentive payment
• APM-specific rewards (depending on model participating
• Exclusion from MIPS
APMs require the collection of Patient-Reported Outcome Measures (PROMs) and Patient- Reported Experience Measures (PREMs). These are used to demonstrate the quality of the provision of care based on the reported perception of the most important stakeholder in health care, the Patient.

CODE Technology collects the required data with no added administrative burden or patient time within the clinic. Patient experience and ratings are influenced by the time a patient is in the clinic and the amount of paperwork they are expected to complete. Increase patient throughput and satisfaction by taking the collection of this important information out of the clinic. Let CODE do the heavy lifting and collect data at a higher rate than before.
To learn more about APMs click on the link below:
Advanced APMs – QPP (cms.gov)

Download A Guide to Orthopedic Payment Models: MIPS, APMs, Bundles, and more.

Download this guide today to learn more about how CODE Technology can assist you and your organization with APMs

  • How healthcare is tackling the denominator of the value equation; 
  • How MIPS and Advanced APMs work;
  • All the benefits of bundled payments;
  • What gainsharing is and how it works;
  • What co-management is and how it works;
  • How PRO data helps with the numerator of the value equation; and
  • How CODE can help you lower your costs with PROs.

About the Author

CODE Technology

We’re research nerds, and we believe Patient-Reported Outcomes are going to transform healthcare for the better - and we’re not alone. That is why we’re helping organizations collect and interpret as much data as possible, as efficiently as possible. Let us help you help the world.