Making Sense of MACRA: Navigate Changes to the Quality Payment Program in 2018
Here's how to succeed in the four performance categories of the Merit-based Incentive Payment System: quality, cost, improvement activities, and advancing care information.
Fam Pract Manag. 2018 Mar-Apr;25(2):37-40.
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Navigating the Quality Payment Program (QPP) will set you up on a path for success in the four performance categories of the Merit-based Incentive Payment System (MIPS): quality, cost, improvement activities (IA), and advancing care information (ACI).
MIPS-eligible clinicians are required to report six quality measures, including one outcome measure. The 2017 transition year allowed ECs to report on as few as one patient a single time to avoid a negative payment adjustment.
The reporting criteria has increased for the 2018 performance period. Beginning in 2018, ECs are expected to report a full calendar year (January 1-December 31, 2018) of quality data. In addition, the data completeness criteria has increased. ECs reporting using a qualiﬁed registry, qualiﬁed clinical data registry (QCDR), or an electronic health record (EHR) will need to report on at least 60% of patients eligible for the measures selected, regardless of payer. ECs reporting using claims will need to report on at least 60% of Medicare Part B patients eligible for the measures selected.
One of the major changes made in the 2018 QPP ﬁnal rule is the inclusion of cost in the MIPS ﬁ nal score. In the 2017 transition year, cost was not included in the MIPS ﬁnal score.
For the 2018 performance period, cost will carry a weight of 10% and increase to a weight of 30% beginning in 2019. As the weight of the cost category increases, the weight of the quality category decreases.
For the 2018 performance period, the cost category will be measured for a full calendar year and assessed using two measures: Total per Capita Cost and Medicare Spending per Beneﬁciary (MSPB). While these measures were included in the previous Value-based Payment Modiﬁer (VM) program, they are still unfamiliar to many physicians. CMS is developing episode-based measures to be used in future program years. The ﬁrst round of
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