Daily Practice

Advanced Alternative Payment Models (APM)

Alternative Payment Models (APMs) require physicians to take on risk and responsibility for their own cost and quality performance. There are many different styles of APMs. This page is intended to explain the Advanced APMs existing models for radiation oncologists.

To be an Advanced APM, an APM must meet the following three criteria:

  1.  Require participants to use certified electronic health record technology (CEHRT);
  2.  Provide payment for covered professional services based on quality measures comparable to those used in the quality performance category of the Merit-based Incentive Payment System (MIPS); and
  3.  Either: (1) be a Medical Home Model expanded under CMS Innovation Center authority; or (2) require participating APM Entities to bear more than a nominal amount of financial risk for monetary losses.


Participants are eligible for a yearly 5 percent incentive payment in the Quality Payment Program (QPP) for participating in an Advanced APM.


Advanced APMs include the Oncology Care Model with two-sided risk, the Medicare Shared Savings Program, a designated Health Care Quality Demonstration Program and Federally Mandated Demonstrations. A radiation oncology specific APM does not yet exist; however, ASTRO is actively working with the CMS to make this option available in the near future. Unless the Oncology Care Model is applicable, ASTRO recommends that radiation oncologists participate in the MIPS program in 2019.

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