quality payment program - aanem · 2017-01-05 · o majority of clinicians will participate in mips...

Quality Payment Program

Millie Suk, JD, MPP AANEM Health Policy Director

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

Quality Payment Program (QPP): What Is It?

• Medicare Access and CHIP Reauthorization Act (MACRA) of 2015

• Reforms Medicare Part B payments • Clinicians have two tracks to choose from:

o The Merit-based Incentive Payment System (MIPS) o Advanced Alternative Payment Models (APMs)


QPP: MIPS vs. Advanced APMs

• MIPS = Modified fee-for-service mode o Majority of clinicians will participate in MIPS for at least the first couple of

years o Clinicians will have payments increased, maintained, or decreased based

on relative performance in four categories

• Advanced APMs = new payment models that reduce costs of care and/or support high-value services not typically covered under the Medicare fee schedule o Clinicians receive incentive payments for their participation


Details MIPS Advanced APMs

Payment Adjustment +/- 4% in 2019, increases to +/- 9% by 2022

N/A

Bonus Payments Clinicians w/ total MIPS score in top 25% receive additional payment adjustment of up to 10% (available 2019-2024)

5% Incentive Payment (available 2019-2024)

Annual Fee Schedule Update 0.25% beginning in 2026 0.75% beginning in 2026

QPP: MIPS vs. Advanced APMs


QPP: MIPS – Who Participates?

• Not just physicians • Eligible Clinicians:

o Physicians o Physician Assistants o Nurse Practitioners o Clinical Nurse Specialists o Certified Registered Nurse Anesthetists


QPP: MIPS – Who is EXEMPT?

• Clinicians below low-volume threshold o Medicare Part B allowed charges less than or equal $30,000 OR 100 or

fewer Medicare Part B patients

• Newly-enrolled Medicare clinicians o Clinicians who enroll in Medicare for the first time during a performance

period.

• Clinicians significantly participating in Advanced APMs


QPP: MIPS Components

• Quality (replaces PQRS) • Advancing Care Information (ACI) (replaces

“Meaningful Use” of EHRs) • Improvement Activities (IA) (NEW!) • Cost (replaces the cost component of VM)


QPP: MIPS – 2017 Scoring


QPP: MIPS – 2017 “Pick Your Pace” Transition Year


QPP: MIPS – Individual v. Group Reporting

• Individual: report under NPI number and TIN where you assign benefits

• Group: 2+ clinicians (NPIs) who have reassigned their billing rights to a single TIN o Groups will be assessed as a group across all 4 MIPS performance

categories


QPP: MIPS – Get Your Data to CMS


QPP: MIPS – Getting Started

• Determine your eligibility status • Gauge your readiness • Choose if you will be reporting as an individual or a group • Decide if you will work with a third party intermediary (EHR

vendor, QCDR, Qualified Registry, CMS Approved CAHPS Vendor)

• Review the program timeline for dates • Choose a data submission option • Reach agreement with bonus payments and reporting periods • Assess your feedback

(https://portal.cms.gov/wps/portal/unauthportal/home/)


https://portal.cms.gov/wps/portal/unauthportal/home/

QPP: MIPS – Calculating the Final Score


QPP: MIPS – Timeline


QPP: Advanced APMs

• What is an Advanced APM? • APM = payment approach, developed in partnership

with the clinician community, that provides added incentives to clinicians to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population.

• Advanced APM = term established by CMS; these APMs have greatest risks and offer potential for greatest rewards.


QPP: Advanced APMs – CMS Criteria

• 50% of participants must use certified EHR technology

• Must report and at least partially base clinician payments on quality measures comparable to MIPS

• Bear “more than nominal risk” for monetary losses o Less of 8% of total Medicare revenues or 3% of total Medicare

expenditures o Primary Care Medical Homes have different standards


QPP: Advanced APMs – Participation Thresholds


QPP: Advanced APMs – 2017 Models

• Comprehensive End Stage Renal Disease Care Model (2-sided risk)

• Comprehensive Primary Care Plus (CPC+1) • Shared Savings Program Track 2 • Shared Savings Program Track 3 • Next Generation ACO Model • Oncology Care Model (2-sided risk) The list of Advanced APMs is posted at qpp.cms.gov and will be updated with new announcements on an ad hoc basis.


QPP: MIPS APMs

• APM with at least one MIPS eligible clinician that participates under agreement with CMS (but doesn’t qualify as an Advanced APM)

• Payment incentives based on performance on cost and quality

• Advanced APM benefits do NOT apply – must still participate in MIPS o In 2017, MIPS APMs receive full Improvement Activities credit o Have simplified MIPS reporting


QPP: Additional Information

https://www.aanem.org/Practice/Medicare/MACRA


https://www.aanem.org/Practice/Medicare/MACRA

QPP: Questions? E-mail: [email protected] Phone: 507- 288-0100 (ask for Millie or Carrie)


mailto:[email protected]

quality payment program - aanem · 2017-01-05 · o majority of clinicians will participate in mips...

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