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CMS Offers Physicians QPP Prep in Advance of Transition

News  |  By Christopher Cheney  
   December 16, 2016

Webinars detail the new Medicare Quality Payment Program's two-track structure, which kicks off with voluntary performance-category reporting in January.

Most physicians are all too happy to ring out the Sustainable Growth Rate formula for payments with the end of 2016, but there are many questions about its replacement.

As the phase-in of Medicare's new Quality Payment Program (QPP) approaches, the Centers for Medicare & Medicaid services is presenting webinars to prepare clinicians for the change.

The QPP, which was adopted under provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), features two value-based payment tracks for clinicians: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

Two Payment Tracks
The start of 2017 marks the beginning of the transition year for QPP, during which clinicians can pick the pace of their adherence to the reporting requirements for MIPS during the year.

Clinicians who decide to report no MIPS data in 2017 face a 4% payment penalty in 2018.

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Clinicians have three MIPS reporting-pace options for 2017, with payment adjustments ranging from "neutral or small" for reporting minimal data to a "modest" bonus for reporting complete MIPS data in 2017.

The reporting requirements will become mandatory in 2018, and the new QPP clinician-reimbursement system is slated for full implementation in 2019.

So far, the Centers for Medicare & Medicaid Services webinars about the new payment system have included overviews of MIPS, the QPP, and advanced APM.

On December 13, CMS presented a webinar on two of the four reporting performance categories for MIPS: advancing care information and improvement activities.

CMS plans to present a webinar on the two other MIPS performance categories—quality and cost—next month.

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Clinicians can take a "pick-your-pace" approach to MIPS data reporting in 2017, but selecting the fastest pace will generate the highest possible payment bonus for clinicians next year and help prepare them for the mandatory reporting requirements that begin in 2018, CMS Senior Technical Adviser Elizabeth Holland said during the December 13 webinar.

"The MIPS payment adjustments are based on the data submitted, so the best way to get the maximum MIPS payment adjustment is to participate for the full year," Holland said.

"When you participate for the full year, you get the most measures to choose from and you will have more reliable data submitted. We are encouraging people to pick the participation pace that is best for them."

Clinicians eligible to participate in MIPS include:

  • Physicians
  • Physician assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Certified registered nurse anesthetists

In 2017, MIPS data-reporting payment adjustments will be drawn from three of the four performance categories: quality, advancing care information, and improvement activities.

The QPP formula for data-reporting payment adjustments next year will be weighted, with the quality category receiving the highest consideration: quality, 60%; advancing care information, 25%; and improvement activities, 15%.

Christopher Cheney is the CMO editor at HealthLeaders.

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