Quality Payment Program - MIPS and APM

In late April 2016, CMS released the first major rule under the Medicare Access and CHIP Reauthorization Act (MACRA).  This provides a compreshensive view of how new payment tracks will work under MACRA.  It also highlights the fact that the start of the first performance period under these new payment tracks is January 1, 2017.  Payments would be adjusted in 2019 to reflect performance in 2017.

The new rule has major implications for health systems and commercial health plans, in addition to clinicians. 

The proposed rule provides for two payment tracks: the Merit-Based Incentive Payment System (MIPS) track, and the Advanced Alternative Payment Model (APM) track.  CMS is now referring to these two tracks collectively as the Quality Payment Program (QPP).

MIPS

It is expected that most clinicians will be on the MIPS track in the early years of this new program.  It will be important for clinicians to understand and carefully assess their performance in the four categories that will comprise the MIPS score:

• Quality (50 percent)
• Resource Use (10 percent)
• Clinical Performance Improvement Activities (15 percent)
• Advancing Care Information (formerly known as meaningful use of EHR technology) (25 percent)

Advanced APM

CMS expects the number of clinicians qualifying for Advanced APM incentives to increase over time; however, projections are that notably fewer clinicians will qualify under the APM track than will fall under the MIPS track in 2019.  There are six current APMs included in the Advanced APM list in the new rule:

• Next Generation ACO Model
• Medicare Shared Savings Program (MSSP)
• MSSP Track 2
• Comprehensive End-Stage Renal Disease Care - Large Dialysis Organization Arrangement
• Comprehensive Primary Care Plus (CPC+) - available in 2017
• Oncology Care Model Two-Sided Risk Arrangement - available in 2018

Both tracks are designed to support three overarching goals:

• Improving how clinicians are paid to incentivize quality and value,
• Improving the way care is delivered, and
• Making data more available and enabling the use of certified EHR technology to support care delivery.

JCS has experience helping organizations understand, plan for, and implement the processes and technology necessary to support these payment tracks. We understand healthcare organizations, payer organizations, and the types and sources of data required to meet various reporting requirements.  We can help implement these programs in your organization, or improve what you already have.  We can also help you analyze your data and improve your outcomes.  For more information, please Contact Us directly.