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Quality Payment Program Highlights

Two Payment System Options:  You Choose What Works Best for Your Practice
  1. Merit-based Incentive Payment System (MIPS): fee-for-service plus streamlined reporting on quality, cost, improvement activities, and electronic health record (EHR) meaningful use (known now as advancing care information)

    1. Sliding-scale bonuses or cuts based on reporting and performance in four categories: quality, resource use, advancing care information (EHR meaningful use), and improvement activities

    2. Ability to be exempt if you are new Medicare provider, care for a low volume of Medicare patients, or are a qualified participant in an Advanced APM

  2. Advanced Alternative Payment Models (APM): No MIPS reporting requirement

    1. Advanced APMs include medical homes, accountable care organizations (ACOs), and demonstrations under the Medicare Health Care Quality Demonstration Program

    2. Physicians practicing within an APM who meet the patient or revenue thresholds will receive a 5% bonus between 2019 and 2024 and a 0.75% increase in the Physician Fee Schedule in 2026 and beyond.

2017 Transition Reporting Options

In order to ensure the implementation of the Quality Payment Program is successful for as many physicians and other Medicare providers as possible, CMS created 4 reporting options for 2017.  Choosing one of these options will ensure that physicians do not receive penalties during the first payment period.  For performance year 2017, reporting ends March 31, 2018.

Option 1: Physicians can submit one measure in quality, advancing care information, or improvement activities at some point in 2017 in order to avoid negative payment adjustments in MIPS.  

Option 2: Physicians can choose to submit data for at least 90 days rather than the full year.  Physicians who select this option may receive a small positive payment adjustment.  

Option 3: In practices that are ready to fully implement reporting on January 1, 2017, physicians can opt to submit data for the entire year-long performance period.  Physicians who select this option may receive a payment adjustment of up to 4 percent.

Option 4: Instead of reporting through MIPS, physicians can participate in an Advanced APM.  If they see enough Medicare patients or receive enough Medicare payments through the Advanced APM during the performance period, they can receive a 5 percent bonus.  

 

Cost-Conscious Cases:

Physicians have a responsibility to our patients and society to “do no harm” which includes providing cost-conscious medical care.

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