On January 1, the first performance period of MACRA’s new Quality Payment Program officially began, with providers looking for guidance from the Centers for Medicare and Medicaid Services to ensure that they are ready to participate in 2017 and avoid a negative payment adjustment in 2019.
The new reimbursement program for physicians and their group practices looks to revamp how clinicians are paid for services to Medicare beneficiaries, emphasizing quality of care services rather than a fee-for-service framework. As part of the MACRA initiative, physician use of information technology will be folded in to calculations. In addition, the ability to gather quality data is expected to be highly dependent on practices’ IT systems.
The QPP, which will involve Medicare Part B payments for about 600,000 clinicians, has two tracks to choose from: the Merit-Based Incentive Payment System (MIPS) or the Advanced Alternate Payment Models (APMs). However, because of the complexity of the program, there seems to be a fair amount of confusion among providers.
“People are still, I think, getting up to speed and learning what the rules of the road are,” said Kate Goodrich, MD, director of the CMS Center for Clinical Standards and Quality, during a special session on Tuesday at the HIMSS17 conference in Orlando. “People really want to know their eligibility status. We’ve been hearing that a lot. They want to know if they are eligible for MIPS or not.”
To be eligible, clinicians must bill more than $30,000 a year under Medicare Part B and provide care for more than 100 Medicare patients per year. They must meet both the minimum billing and the number of patients to be included in the QPP. If they are below either, they will not be a part of the program.
At the same time, CMS established a low-volume threshold to help small practices gain exemptions from the new requirements. In 2017, small practices can be excluded from new requirements if they have less than $30,000 in Medicare Part B allowed charges or less than 100 Medicare patients.
“We’ll be notifying folks of their status in the very near future—hopefully, within the next month or six weeks or so,” added Goodrich. “We will be telling people soon enough, letting people know where they stand.”
According to Goodrich, CMS designed MACRA’s QPP “not to be a single-file march but a program where clinicians and care systems can pick their own pace and their own path.”
If providers choose the MIPS path for the QPP, they have three options: submit a minimum amount of 2017 data to Medicare—such as one quality measure—to avoid a downward payment adjustment; submit 90 days of 2017 data to Medicare to earn either a neutral or positive payment adjustment; or submit a full year of 2017 data to Medicare to earn a positive payment adjustment.
If practices don’t participate in the QPP and decline to send in any 2017 performance data, then they’ll receive a negative 4 percent payment adjustment.
“You get to pick your pace for the Quality Payment Program,” states the QPP website. “If you're ready, you can begin January 1, 2017, and start collecting your performance data. If you're not ready on January 1, you can choose to start anytime between January 1 and October 2, 2017. Whenever you choose to start, you'll need to send in your performance data by March 31, 2018. You can also begin participating in an Advanced APM.”
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