MACRA 101: Quality Payment Program
The Centers for Medicare and Medicare Services (CMS) has named the new clinician payment system under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) as the Quality Payment Program. The primary goal of the program is to reward clinicians for quality patient outcomes, rather than paying for the volume of services provided. Regardless of whether a clinician participates in the Merit-Based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model (Advanced APM), clinicians will be assessed on the quality of care provided.
Under MIPS, clinicians will be assessed based on performance against quality measures developed by the ACC, the American Heart Association (AHA) and other stakeholders. A list of ACC/AHA measures proposed for reporting under MIPS [PDF] is available . Most of these measures will be familiar to clinicians as measures currently reported under the Physician Quality Reporting System (PQRS).
CMS proposes that the process of reporting quality measures will remain similar to what clinicians and practices are currently familiar with under PQRS. Clinicians and practices will still have the option of reporting data as individuals (TIN/NPI) level or at the group practice level (practice TIN). CMS proposes that measure data can still be submitted via claims, electronic health records (EHRs), qualified registries, or a Qualified Clinical Data Registry (QCDR) such as the ACC's PINNACLE Registry and Diabetes Collaborative Registry. Reporting via a QCDR will continue to offer benefits, such as the ability to report measures outside of those approved as "MIPS measures."
The structure of the MIPS Quality component remains similar to PQRS in many ways, meaning that clinicians who are currently successfully reporting to PQRS should easily transition to reporting under the MIPS Quality component. Based on 2014 PQRS performance, CMS reported that 76 percent of cardiologists reported to PQRS, with the majority avoiding penalties by successfully meeting reporting requirements.
CMS proposes to improve quality reporting under MIPS in other ways:
- Reduced reporting requirement of nine quality measures across three National Quality Strategy (NQS) domains to six quality measures with no domain requirement
- Award bonus points for reporting "high priority measures" — outcome, patient experience, appropriate use, patient safety and EHR reported measures.
For most clinicians or groups participating in MIPS, quality measure reporting will count toward 50 percent of the clinician’s MIPS composite score.
CMS proposes that a clinician or group will receive 1-10 points for each measure based on performance against a historical benchmark. Zero points will be awarded for measures in which there is no data. All reported measures for which there is data will be averaged to create a score for the category.
Quick Tips to Prepare for Quality Reporting
- Determine how you are currently reporting quality to CMS. Are you participating in PQRS, or are you in an alternative payment model (APM)?
- If you are successfully participating in PQRS, many of your current measures and reporting processes will carry over under MIPS.
- If you are in an APM, you may not be participating in PQRS. Instead, you may be reporting measures specific to your model (i.e., accountable care organization measures) and meeting requirements specific to that model. This activity will be recognized under MIPS or an Advanced APM under MACRA.
- Access your PQRS Feedback and Quality and Resource and Use Reports (QRURs) to determine your current quality performance as measured by CMS. The 2015 reports will be available in September. These reports are available through the CMS Enterprise Identity Management System. It may be a member of your team or staff who holds the login for your practice.
- Make sure you’re up to speed on your 2016 PQRS reporting.
- Determine if QCDR quality reporting is appropriate for you.
- Become familiar with the quality measures most applicable to your practice and patient population.
Review "MACRA: A New Era for Medicare Payment" for an overview of how the new payment system will impact you and your practice. Stay tuned for articles on the other core components of MIPS: Resource use, EHR use, and clinical practice improvement. A list of MACRA frequently asked questions is also available.
Keywords: Accountable Care Organizations, American Heart Association, Benchmarking, Centers for Medicare and Medicaid Services, U.S., Diabetes Mellitus, Electronic Health Records, Group Practice, Mandatory Reporting, Medicare, Motivation, Patient Safety, Physicians, Registries, Reward, Renal Dialysis
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