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)
American Association of Neuromuscular & Electrodiagnostic Medicine - 2016
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
American Association of Neuromuscular & Electrodiagnostic Medicine - 2016
QPP: MIPS vs. Advanced
APMs
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
American Association of Neuromuscular & Electrodiagnostic Medicine - 2016
QPP: MIPS – Who
Participates?
• Not just physicians
• Eligible Clinicians:
o
o
o
o
o
Physicians
Physician Assistants
Nurse Practitioners
Clinical Nurse Specialists
Certified Registered Nurse Anesthetists
American Association of Neuromuscular & Electrodiagnostic Medicine - 2016
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
American Association of Neuromuscular & Electrodiagnostic Medicine - 2016
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)
American Association of Neuromuscular & Electrodiagnostic Medicine - 2016
QPP: MIPS – 2017 Scoring
American Association of Neuromuscular & Electrodiagnostic Medicine - 2016
QPP: MIPS – 2017 “Pick
Your Pace” Transition Year
American Association of Neuromuscular & Electrodiagnostic Medicine - 2016
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
American Association of Neuromuscular & Electrodiagnostic Medicine - 2016
QPP: MIPS – Get Your Data
to CMS
American Association of Neuromuscular & Electrodiagnostic Medicine - 2016
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/)
American Association of Neuromuscular & Electrodiagnostic Medicine - 2016
QPP: MIPS – Calculating the
Final Score
American Association of Neuromuscular & Electrodiagnostic Medicine - 2016
QPP: MIPS – Timeline
American Association of Neuromuscular & Electrodiagnostic Medicine - 2016
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 costefficient 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.
American Association of Neuromuscular & Electrodiagnostic Medicine - 2016
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
American Association of Neuromuscular & Electrodiagnostic Medicine - 2016
QPP: Advanced APMs –
Participation Thresholds
American Association of Neuromuscular & Electrodiagnostic Medicine - 2016
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.
American Association of Neuromuscular & Electrodiagnostic Medicine - 2016
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
American Association of Neuromuscular & Electrodiagnostic Medicine - 2016
QPP: Additional
Information
https://www.aanem.org/Practice/Medicare/MACRA
American Association of Neuromuscular & Electrodiagnostic Medicine - 2016
QPP: Questions?
E-mail: [email protected]
Phone: 507- 288-0100 (ask for Millie or Carrie)
American Association of Neuromuscular & Electrodiagnostic Medicine - 2016