Orthopedic Payment Models: MIPS, APMs, Bundles, and More

July 03, 2017


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

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 the 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)

See the Orthopedic Payment Models Guide

or Schedule a Call with a CODE PRO Expert