MACRA-Quality Payment Program
The CMS Final Rule for the New Medicare Quality Payment Program (QPP) was released on October 14. The Quality Payment Program has significant changes designed to bolster support for small practices and rural settings as well as connect multiple programs into a unified clinician-driven Quality Improvement program.
Mountain-Pacific, Health Technology Services will be providing checks, resources and guidance to help you navigate this new process that include webinars and a new MACRA blog. Let us help you navigate the MACRA-QPP process.
Be sure to subscribe to our new MACRA-Quality Payment Program blog.
What is the Quality Payment Program?
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ends the Sustainable Growth Rate formula, streamlines Medicare reporting programs and provides opportunities for providers to earn more by focusing on quality patient care. CMS refers to these provisions of MACRA collectively as the Quality Payment Program (QPP).
Providers can now choose how to take part in the Quality Payment Program based on practice size, specialty, location, or patient population. The Quality Payment Program has 2 tracks you can choose from:
- The Merit-based Incentive Payment System (MIPS)
- Advanced Alternative Payment Models (APMs)
Who is eligible to participate in MIPS?
You are eligible to participate in the MIPS track of the Quality Payment Program if you bill more than $30,000 to Medicare and provide care to more than 100 Medicare patients per year and are a Physician, 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 required to participate in the Quality Payment Program in 2017.
What should I do now to report for MACRA-Quality Payment Program in 2017?
MACRA-QPP encompasses the current legacy programs of PQRS, MU and Value Modifier. Therefore, if you have been engaged in all or some of these programs, the QPP will be familiar.
Identify your “eligible clinicians” which is the term used for those participating in MIPS.
Low volume thresholds are stated to determine if you will be participating as defined by CMS. Clinicians exempt from MIPS do not meet the threshold if they have ≤ $30,000 in Medicare charges OR ≤ 100 Medicare patients. This threshold can be reviewed at the individual level or the Group level. Remember though, if you pick the Group level for reporting, then all providers under that TIN will need to report at the Group level.
Review the flexible options for reporting MIPS in 2017 to determine what is best for your organizational strategy and financial consequences.
If you participate at any of the levels in 2017, you will avoid a negative payment in 2019. If you DO NOT report, you will receive a -4% negative payment adjustment on all Medicare Part B payments in 2019. Payments to clinicians are adjusted based on the MIPS Final Score and reporting by your organization.
Assess the 3 reporting Categories for 2017 to identify which options align with your clinical quality goals and will result in improving your patient care and reporting outcomes.
Here is a link to a summary of reporting options for the 3 Performance Categories – MIPS Measures Overview.
What models are Advanced APMs?
In 2017, CMS anticipates that the following will be Advanced APMs –
- Comprehensive ESRD Care (CEC) – Two-Sided Risk
- Comprehensive Primary Care Plus (CPC+)
- Next Generation ACO Model
- Shared Savings Program – Track 2
- Shared Savings Program – Track 3
This list may change. CMS will publish a final list before January 1, 2017.
CMS has a comprehensive list and table classifying the 2017 APM models and Alternative Payment Models in the Quality Payment Program.
MACRA-Quality Payment Program Blog
Subscribe to our MACRA-QPP blog where we will share information on the new CMS Quality Payment Program. This blog will help provide timely information, ideas and tools to help you through the decisions and tasks necessary to report in 2017 to avoid penalties and in some cases possibly receive positive adjustments along with helpful advice, tips and best practices.
Quality Payment Program Resources
CMS QPP Program Website designed to be a “One Stop Shop” for all QPP information, education, tools and program updates.
CMS Education and Tools
QPP Final Rule (over 2000 pages). There is a comment period for the final rule also which will end 60 days from October 14, 2016.
Read the Executive Summary Rule, (24 pages)
Quality Payment Program Fact Sheet, (12 pages)
Explore Measures – Click on the Next: Explore Quality Measures button at the bottom of each page to walk through the measures.