Quality Payment Program (QPP)

About the QPP

The Quality Payment Program (QPP) changes the way Medicare pays clinicians for Part B services, offering financial incentives for providing high value care, and adjusting payments accordingly by the year 2019. Established as part of the Final Rule for the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), the QPP has two distinct paths:

  1. The Merit-Based Incentive Payment System (MIPS)
  2. Advanced Alternative Payment Models (Advanced APMs or AAPMs)

Most Medicare Part B clinicians will participate in MIPS. Some will become qualified participants through participation in an Advanced APM (AAPM). Found out more about MIPS eligibility.

MIPS affects “traditional Medicare” (i.e. Part B) and combines facets from legacy programs (i.e PQRS, Value-Based Modifier, and Meaningful Use), and shifts payments to a performance-based system with these categories:

  1. Quality Measures: Key changes from Physician Quality Reporting System (PQRS) program include reduced reporting from 9 measures to 6, with no NQS Domain requirement; and an emphasis on outcomes measures.
  2. Cost: Key changes from Value-based Modifier program include adding 40+ episode specific measures to address specialty concerns.
  3. Promoting Interoperability: Key changes from the Medicare Meaningful Use (MU) EHR Incentive Program* include no “all or nothing” and threshold measurement; removal of “one-size-fits-all” perspective; removal of redundant measures; removal of CDS and CPOE objectives; and reduction of public health reporting measures.
  4. Improvement Activities: This category provides the opportunity for each clinic or eligible clinician to choose activities in order to improve patient experience, staff satisfaction, or workflow processes.

QPP-RCAs you'll see from the following information, MIPS is complicated. How you decide to approach your participation in the program now will make a big difference down the road. Subject-matter experts at Purdue Healthcare Advisors have carefully studied how each MIPS performance category is scored in order to help you best plan your strategy for Performance Year 2018. Contact PHA's Natalie Stewart to discuss how we can work with you to maximize your efforts. Check our events page for webinars  on the topic. If you are a small-practice provider, learn more about how the QPP Resource Center™ of the Midwest can help you with MIPS.

MIPS PERFORMANCE MEASURES

Providers are assessed annually in four weighted categories (shown below). Flexibility within categories allows clinicians to choose activities & measures most meaningful to them. A Composite Performance Score (CPS) is then assigned, based on a 0-100 scale. Performance decrees payment adjustments, which increase over time.

QUALITY

• 2019 weighting: 45%
• Choose six (6) measures on which to be evaluated including an outcomes or high priority measure
• Select from individual measures or a specialty set

COST

• 2019 weighting: 15%
• No reporting requirement for clinicians
• CMS calculates based on adjudicated claims

IMPROVEMENT ACTIVITIES

• 2019 weighting: 15%
• Nine (9) categories
• 90+ Improvement Activities / Must select at least one (1) to avoid zero score
• PCMH receives full credit

PROMOTING INTEROPERABILITY

• 2019 weighting: 25%
• Must be on 2015 certified software
• 5 measures + 2 bonus measures will determine your total PI score
• Participate as individual or group
• Flexible scoring for measures

Adjustments are applied on a linear sliding scale two years after the performance year. The performance threshold is a mean or median of the composite score for all MIPS providers, and the score methodology accounts for:

  • weights of each performance category;
  • exceptional performance (a final score of 75 or above qualifies);
  • flexibility of measures for various categories of clinicians (e.g. specialty, individual or group reporting); and
  • special circumstances for small practices, rural practices, and non-patient-facing MIPS eligible clinicians.

*MIPS does not change the requirements under the Medicaid EHR Incentive Program. If you are participating in Medicaid MU, you must continue to comply with the established requirements under that program. If you are a Medicaid MU participant who also has Medicare Part B claims, then you will report to both programs.

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