Alternative Payment Models

Resources to assist member hospitals

Below are a number of resources to help member hospitals understand the regulatory framework as they move toward development and implementation of one or more alternative payment models (APMs). The information includes:

  • General and program-specific resources for mandatory models such as the Comprehensive Care for Joint Replacement (CJR) Model
  • Voluntary models such as the Medicare Shared Savings Program (MSSP) and the Bundled Payments for Care Improvement Initiative (BPCI)
  • Models that qualify as advanced alternative payment models for physician payment incentives under the Medicare Access and CHIP Reauthorization Act of 2015  

In addition, we have provided a list of helpful Centers for Medicare & Medicaid Services (CMS) website links under each of the tabs below for additional information.

As CMS continues to support new alternative payment and delivery models to reward better, more efficient, coordinated patient care, CHA encourages members to follow this page. It will be updated regularly with general and program-specific resources as they become available.

Available Resources

Recent Activity

CHA Issues Summary of Proposed Changes to Comprehensive Care for Joint Replacement Model

CMS Proposes Modifications, Extension of Joint Replacement Model

HHS Advances Payment Model to Lower Drug Costs for Patients

CHA Submits Comments on Medicare Shared Savings Program Proposed Rule

General APM

CHA Alternative Payment Model Guiding Principles

Request for Information on New Direction for CMS Innovation Center (Nov. 2017)

CMS Innovation Center Website

CJR

CJR Model 3 Year Extension and Changes to Episode Definition and Pricing Proposed Rule comments due April 6, 2020

Final Rule – Extreme and Uncontrollable Circumstances Policy for the CJR Model issued June 8, 2018

Final Rule – Cancellation of Episode Payment Model and Changes to CJR – issued Nov. 30, 2017

CJR Final Rule Member Forum Recording

BPCI

CMS Announces Bundled Payments for Care Improvement Advanced Model 

CMS Bundled Payments for Care Improvement Initiative Web Page (Tracks 1-4)

HLB White Paper on Bundled Payments for Care Improvement Initiative (Oct. 2011)

MSSP

Medicare Shared Savings Program “Pathways to Success” Proposed Rule

MSSP Extreme and Uncontrollable Circumstances Policies for Performance Year 2017 Interim Final Rule

Revisions to MSSP Benchmarking Methodology Final Rule (June 2016)

Updated ACO Waivers under the MSSP Program (Oct. 2015)

Updates to MSSP Program (Track 3) Final Rule (Jun. 2015)

Medicare Shared Savings Program: Accountable Care Organizations Final Rule (Oct. 2011)