Let's begin our learning course with a
brief background of the Quality Payment
Program. The Quality Payment Program
began in 2017 as a result of the
Medicare Access and CHIP Reauthorization
Act of 2015, or MACRA for short. MACRA
required CMS by law to implement an
incentive program, which is referred to
as the Quality Payment Program. There are
two ways to participate in the Quality
Payment Program. One is the Merit-based
Incentive Payment System or MIPS and the
other is Advanced Alternative Payment
models or Advanced APMs. In this course
we will look at a high-level overview of
year two of the program, which is the
2018 performance year. It's important to
recognize the top seven strategic
objectives or commitments for the
Quality Payment Program moving into year
two. Improving beneficiary outcomes
remains at the top of the list along
with reducing clinician burden. Other
commitments include maximizing
participation in the program and
increasing the adoption of Advanced
APMs
to include more clinicians and provide
them with more options. Improving data
information sharing along with ensuring
operational excellence are also a focus.
Making sure information technology
systems have capabilities that meet the
users’ needs is another priority for
year two. Next we will take a brief look
at the MIPS and Advanced APM paths of
participation. Under MIPS, a smooth
transition was created to a new payment
system that promotes high-quality,
efficient care through the unification
of 3 CMS legacy programs. The three
legacy programs include the Physician
Quality Reporting System or PQRS, the
Physician Value Payment Modifier, and the
Medicare Electronic Health Record or EHR
Incentive program.
MIPS adjusts clinician payment based on
four performance categories, which are
similar to the 3 CMS legacy programs. For
Year 2 of the program or 2018, the same
four performance categories exist as the
2017 transition year. One category that
was previously called Advancing Care
Information is now called Promoting
Interoperability in 2018. They include
Quality, which resembles PQRS, Cost, which
aligns with the Physician Value Modifier
Program, Promoting Interoperability, which
resembles the Medicare EHR Incentive
Program or Meaningful Use, and
Improvement Activities. You will learn
more about MIPS for Year 2 of the
Quality Payment Program in lesson two.
The second way to participate in the
Quality Payment Program in Year 2 is via
an Advanced Alternative Payment Model.
Let's take a look at a snapshot of this
path. Alternative Payment Models, or APMs,
are payment approaches that provide
added incentives to clinicians to
provide high quality and cost efficient
care. The MACRA statute defines APMs
fairly broadly to include all CMS
Innovation Center models, the Medicare
shared savings program, and any
demonstrations under the healthcare
quality demonstration program or any
other demonstrations required by federal
law.
Advanced APMs are a subset of APMs and
provide the opportunity for clinicians
to receive greater rewards for taking on
some risk related to patient outcomes. To
be an advanced APM, a model must meet
three requirements. First, the APM must
require participants to use certified
EHR technology. Second, the APM must
provide payment for covered professional
services based on quality measures
comparable to those used in the MIPS
quality performance category. And third,
the APM is either a Medical Home Model
expanded under CMS Innovation Center
authority or the APM requires
participants to bear more than a nominal
amount of financial risk. You will learn
more about Advanced APMs
in lesson 3. CMS is here to help eligible
clinicians navigate through the
participation steps and program
requirements for 2018 and beyond. The CMS
Quality Payment Program website at qpp.
cms.gov houses resources for MIPS
performance categories and APMs to
assist eligible clinicians and their
staff on how to successfully fulfill the
requirements for participation in Year
2. CMS encourages you to visit the
website and benefit from all of the
resources it has to offer.
CMS also has organizations to provide
help to clinicians at no cost who are
eligible for MIPS and should actively
participate during Year 2 of the
Quality Payment Program. If you wish to
request one-on-one technical assistance,
please locate the appropriate support
center based on your practice
characteristics, such as size and
geographic location.