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MIPS APMs

A MIPS APM is a special scoring standard for participants in certain APMs.  Initially, most MIPS APMs will be one of the following:

  • Partial QPs in Advanced APMs who opt into MIPS
  • ECs in Advanced APMs below the Partial QP threshold
  • ECs in certain APM tracks that do not meet the nominal risk or other Advanced APM standards (i.e., MSSP Track 1, etc.)

If you are in a MIPS APM you are subject to MIPS. There are, however, significant advantages to being in a MIPS APM that will minimize reporting burden, align program goals, and increase overall performance scoring:

  • Streamlines MIPS reporting and scoring for eligible clinicians in certain APMs. For example, no additional quality reporting is required beyond APM reporting.
  • Aggregates eligible clinician MIPS scores at the APM entity level.
  • All eligible clinicians in an APM Entity receive the same MIPS final score.
  • Uses APM-related performance to the extent practicable.
  • Provides full credit in the Improvement Activities category.
  • Allows continued participation in the APM’s reward program.

Some ECs are in APMs but do not meet the requirements to become QPs or Partial QPs (and are therefore subject to MIPS), or are a Partial QP (and therefore can choose to participate in MIPS).

This APM scoring standard applies to APMs that:

  • Participate under an agreement with CMS;
  • Include one or more MIPS ECs on a Participation List; and
  • Base payment incentives on performance (either at the APM entity level or EC level) on cost/utilization and quality.

Below is a summary of how scores will be weighted in MIPS APMs:

Performance Category 2018 (Year 2) - All MIPS APMs
Quality 50%
Cost 0%
Improvement Activities 20%
Advancing Care Information 30%

Additional important information for 2018:

  • Non-ACO APM participants will now receive a score for the quality component based on their APM participation; same weighting used across all APMs
  • A 4th snapshot date (December 31) will be used to determine if additional ECs in full TIN APMs should be included under MIPS APM scoring