At the beginning of 2017, clinicians had to get on board the moving train that is the Quality Payment Program – or risk losing out on reimbursements from the Centers for Medicare and Medicaid. Twelve month later, and the QPP is still moving full steam ahead, despite a tumultuous regulatory landscape and continued technical confusion surrounding the submission of reporting data.

In November, CMS released its Final Rule for the year, and it will affect nearly all clinicians with significant Medicare patient populations.

Looking back on Year One

The QPP’s first year of performance came to a close on Dec. 31, and what a year it was. Anyone who kept up with healthcare regulation in 2017 likely felt exhausted as the year drew to a close. From vicious congressional debates to the full implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), there wasn’t a dull moment all year.

“Jan. 1 marked the beginning of QPP Year Two.”

Beginning in January 2017, clinicians were able to participate in the Merit-based Incentive Payment System (MIPS) or Alternative Payment Models (APMs), which each sought to offer a smarter and more effective way to reimburse medical organizations for their services. To introduce a higher level of quality to the care given to Medicare patients, the QPP offered clinicians many objectives. For example, clinicians could improve the quality of care they provide, augment their technology and level of service, advance the level of care information they share with stakeholders, or do their part to make healthcare more affordable.

On December 13, 2017 the Office of the Inspector General released its review of CMS’s management of the QPP. OIG’s study found that, while most surveyed clinicians were aware of the QPP, much uncertainty still exists regarding eligibility and data submission. The organization also reported that CMS has yet to develop a program integrity plan for the QPP. That last point could be troublesome if not remedied in the near future. OIG claimed that a lack of an integrity plan could open the QPP up to a greater risk of fraud and improper payments.

Technical assistance is another pain point that OIG identified. Without help in this regard, many clinicians may decide not to participate in the QPP – which could open them up to fines and fees.

As we start the second year of the QPP, medical organizations should look for ways to improve their technical capabilities, especially as they relate to quality reporting. With a robust platform of integrated technology to work from, clinicians stand a better chance of succeeding in 2018.

Looking ahead to Year Two

QPP took a monumental effort to get off the ground in its first year of existence. As year two begins, CMS hopes to achieve the following goals:

  • Improve beneficiary outcomes.
  • Reduce burden on clinicians.
  • Increase adoption of Advanced APMs.
  • Maximize participation.
  • Improve data and information sharing.
  • Ensure operational excellence in program implementation.
  • Deliver IT systems capabilities that meet the needs of users.

To reach these goals, participants are given a score out of 100, based on the type of information they transmit to CMS during the next year. The final score is weighted in this way:

  • Quality: 50 points.
  • Cost: 10 points.
  • Improvement activities: 15 points.
  • Advancing care information: 25 points.

Year One participants will notice the addition of cost in Year Two. Cost replaces the value-based modifier, and in 2018 CMS will use it when considering reimbursement figures. This category is based on the per capita costs all attributed beneficiaries.

Another major change from Year One is the low-volume threshold increase for MIPS-eligible clinicians. In 2018, MIPS includes clinicians who bill more than $90,000 per year in Medicare Part B and provide care to more than 200 Medicare patients per year. Exemptions, however, have not changed from last year.

To learn how customized technology can help your organization get the maximum reimbursement from the QPP, contact Tangible Solutions today.