Quality Reporting and Quality Payment Program
To improve patient outcomes and avoid federal penalties, physicians, clinicians and hospitals must measure the quality of care they provide and then use those measures to make necessary changes. Sounds simple enough. But most providers struggle with choosing the most effective quality measures and correctly tracking and reporting them, let alone achieving improved outcomes and earning incentive payments.
Mountain-Pacific Quality Health has experts on staff to help eligible health care providers better understand
- the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015;
- the two MACRA-Quality Payment Program tracks: the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs);
- and how they relate to the Physician Quality Reporting System (PQRS), the value-based payment modifier (VM or VBM) and the Medicare electronic health record (EHR) incentive programs.
We also provide assistance with quality reporting and incentive payment programs for a number of health care settings.
If you have questions or need help with MIPS requirements, switching to an APM, the Meaningful Use of your EHR or quality reporting programs, please contact us today.
To provide better and more efficient care to Medicare beneficiaries, the Centers for Medicare & Medicaid Services (CMS) streamlined its quality reporting programs. This was done through MACRA and the Medicare Quality Payment Program (QPP).
The QPP gives providers two options:
- Merit-based Incentive Payment System (MIPS)
- Alternative Payment Models (APMs)
MIPS combines parts of PQRS, VM (or VBM) and the Medicare electronic health record (EHR) incentive programs into one program. In 2019, MIPS will begin to pay eligible physicians and clinicians for providing care based on four performance categories: advancing care information, clinical practice improvement activities, cost and quality.
APMs provide incentive payments for high-quality, cost-efficient care. They are designed for physician-based and rural providers who have teamed up to give coordinated, quality care to Medicare patients. Advanced APMs are a subset and let practices earn more for taking on risk related to patient outcomes.
Physicians and clinicians must participate in one of these two tracks. You can choose measures and activities according to the kind of care you provide. Mountain-Pacific can help you move from existing quality programs into the track that is right for you.
You are part of the Quality Payment Program if
- you are in an Advanced APM or
- you bill Medicare more than $30,000 per year and provide care for more than 100 Medicare patients per year (must meet both minimum billing and patient requirements).
For MIPS, you must also be a
- physician assistant,
- nurse practitioner,
- clinical nurse specialist or
- certified registered nurse anesthetist.
If 2017 is your first year participating in Medicare, then you are not in the MIPS track of the QPP.
Mountain-Pacific has several support services for QPP providers:
- Assistance and information about MACRA and its timeline
- Educational learning modules, including opportunities for continuing medical education (CME) – category 1 units
- Monthly learning and action network (LAN) webinars that include opportunities for sharing, participation and Q&As
- Other educational tools and resources
We can help you understand MACRA, MIPS and APMs, so you can reach your performance goals. Please contact us with any questions.
Mountain-Pacific provides quality reporting support and education to
- inpatient and outpatient hospitals,
- critical access hospitals (CAHs),
- inpatient psychiatric facilities (IPFs),
- ambulatory surgical centers (ASCs).
We can help you improve the quality and efficiency of the care you provide. Through assistance, learning and action network (LAN) webinars and educational materials, we support health care facilities with Meaningful Use, value-based payment incentives and quality reporting programs.
Please contact us for more information.
Get up-to-date information about MACRA-QPP, Meaningful Use and PQRS by visiting our blog page. Subscribe to any of our blogs to get the latest news and updates delivered directly to your inbox.
Sharon Phelps, RN, BSN, CPHIMS, CHTS-CP
Cathy Nelson, RN
Preston Groogan, BA
Contact us to learn more about our services.
Tools and Resources
See our Quality Improvement Initiative tools and resources.