Advanced Alternative Payment Models. Part I: Understanding the Medicare Shared Savings Program

With CMS establishing preliminary definitions for fully qualifying Advanced Alternative Payment Models (APMs) in May 2016, it has become of interest to many care providers accepting Medicare and Medicaid payments to understand the nature of these entities if they wish to eventually participate in one of the current or future payment models. Changes under the Medicare Access and CHIP Reauthorization Act of 2015 specifically identify subsets of APMs that allow providers to avoid possible negative adjustments for poor relative performance compared with their respective peer groups through the Merit-Based Incentive Payment System beginning in 2017. This article reviews the nature of one of the fully qualifying Advanced APMs, the Medicare Shared Savings Program, and its risk/benefit sharing principles. Due to the lack of specialty-specific elements, this program acts as a very broad APM for practices and organizations seeking participation in either a simple or Advanced APM for the 2018 reporting period and beyond.