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New CMS Quality Payment Program

New CMS Quality Payment Program

On Wednesday, April 27, 2016, CMS published a Notice of Proposed Rule Making for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) concerning the Quality Payment Program. 

Currently, there is patchwork programs on value and quality through the MACRA legislation.  The major current programs are the Physician Quality Reporting System, the Value Based Modifier program and the Medicare Electronic Health Record Incentive Program.  

Through the new legislation, Congress has combined these programs into on new Merit-based Incentive Payment Program (MIPS).  Most providers will initially participate in the Quality Payment Program through MIPS beginning with the January 1, 2017 reporting period. 

The Quality Payment Program will have four components: 

  • Cost (10% of the total score in year 1)—The score will be based on Medicare claims with no other reporting requirements for providers.  This replaces the Value Based Modifier Program
  • Quality (50% of the total score in year 1)—Providers will report six measures much like they do for PQRS currently.  This replaces the PQRS program.
  • Clinical Practice Improvement (15% of the total score in year 1)—Providers will be measured on activities focused on clinical practice improvement activities such as care coordination, beneficiary engagement, and patient safety.  We have seen no information on the reporting requirements.
  • Advancing Care Information (25% of the total score in year 1)—This program replaces the EHR incentive Program.  It will focus on interoperability and information exchange and will not be all or nothing like the EHR program.

There is an Advanced Alternative Payment Models program that will allow participating providers to be exempt from the MIPS program and be eligible for a 5% Medicare Part B incentive program. 

The MIPS program will be like the current programs and modify payments two years after the reporting year.  The maximum negative adjustments will be 4% for 2019, 5% for 2020, 7% for 2021 and 9% for 2022 and after.  

The rule proposes to allow third parties, including registries, Qualified Clinical Data Registries, health information technology developers and certified survey vendors to act as intermediaries on behalf of providers and submit data for the performance categories as applicable. 

It is our intent, as your technology partner, to develop additional applications and solutions to help you meet these ever changing requirements.

CMS NPRM-QPP-Fact-Sheet-04-27-2016.pdf