The regulations regarding the collection of performance data as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) came into effect in January 2017 and is of tremendous importance to primary care providers (PCPs) because it enacts revised methods of clinician reimbursement for the treatment of Medicare patients. This revised reimbursement model is the Quality Payment Program (QPP).
The focus of the MACRA QPP is to implement a payment model that moves away from the traditional itemized fee-for-service payment to a value-based payment model based on quality outcomes.
The CMS QPP website notes that, while participation is not mandatory, those who don't participate and submit data in 2017 will receive a 4% negative reimbursement adjustment in 2019 for treatment of Medicare patients. PCPs can avoid being penalized by participating in one of two pathways; either through the Merit-based Incentive Payment System (MIPS) or the Alternative Payment Model (APM).
2017 is referred to as the QPP Transition Year, while 2018 is being referred to as QPP Year 2 and is the second year of preparation for QPP Year 3 and beyond.
Similar to the Transition Year of 2017, the 2018 Year 2 of the QPP provides two pathways for participation, MIPS and APM.
There are a number of differences between the participation standards for 2017 and 2018. Here are some of the most prominent ones:
There are also some new items in 2018 that were not available for 2017, including:
Time is rapidly coming to a close to avoid a 4% negative reimbursement adjustment in 2019. The CMS QPP website states, "If you submit a minimum amount of 2017 data to Medicare (for example, one quality measure or one improvement activity for any point in 2017), you can avoid a downward payment adjustment."
There is not much time left to prepare for the 2018 QPP Year 2 participation period. For more specific information click here to go to the CMS Quality Payment Program Year 2 website.
Concordance Healthcare Solutions has management products and services that can help track and improve your MACRA-related activities. Click here to contact us for more information.
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