FPs: Help Frame QPP Cost Measures, Future Payment

Provide Feedback to CMS by Nov. 15

October 31, 2017 03:20 pm News Staff

Family physicians have the opportunity to participate in an online survey about episode-based cost measures.(www.surveymonkey.com) Feedback from physicians who choose to participate, together with responses from other stakeholders, will help CMS determine whether the measures should be considered for potential use in the Quality Payment Program (QPP) as part of the Merit-based Incentive Payment System (MIPS).  

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According to CMS, episode-based cost measures represent the cost to Medicare for the items and services furnished to patients during an episode of care. "Episode-based cost measures are developed to inform clinicians on the cost of care for an episode during which they manage the care for an acute medical condition or perform a procedure," explained CMS in an online fact sheet.(www.cms.gov) 

CMS is field-testing eight measures, two of which likely pertain to family physicians; those measures are

  • simple pneumonia with hospitalization, and
  • intracranial hemorrhage or cerebral infarction (stroke).

A third measure, colonoscopy, is applicable to those family physicians who perform the procedure.

"During the field test, clinicians may access confidential feedback reports with information about their performance on these new measures," said CMS in an email communication to stakeholders.

"The field test (survey) is a voluntary opportunity for stakeholders to comment on the measures specifications and the report template for the eight measures in their current stage of development," said CMS. "This feedback will be considered in refining the measures and for future measure development activities."

There's no time to waste; surveys must be completed by Nov. 15.

AAFP staff experts familiar with the field-testing noted that these inpatient measures represent the first wave of new episode-based cost measures and that CMS will continue developing measures for the QPP; episodes for chronic conditions will be on the table in the future.

Those experts also explained that the measures will be used to calculate a cost score in addition to calculating Medicare spending per beneficiary and total per capita cost. They stressed that it's important for physicians to understand how the calculations will affect Medicare payment in the future.

Indeed, CMS points out in the fact sheet that as the Medicare Access and CHIP Reauthorization Act requires, "the MIPS cost performance category will be weighted at 30 percent in the MIPS final score for the 2019 performance year, meaning that it will affect (physician) payment in the 2020 payment year."

CMS also wants to know from stakeholders

  • if the information presented on the measures in the field test report helps identify actionable improvements to patient care and to cost improvement,
  • if the measures are clinically valid,
  • how the information can be presented to be useful for quality improvement,
  • which portions of the documentation are unclear, and
  • if additional documents or information should be provided to help clinicians better understand the measures.

Field test reports can be accessed through the CMS Enterprise Portal.(portal.cms.gov) Physician groups or solo physicians should have a field test report waiting for them if they had at least 10 cases for any one of the measures outlined above that occurred from June 1, 2016, to May 31, 2017.

Have additional questions? Email CMS for more information about episode-based cost measures.

Interested physicians are also invited to join an upcoming provider call(engage.vevent.com) scheduled for Nov. 2 from 3:30-5 p.m. EDT.

Related AAFP News Coverage
MACRA: The Medicare Access and CHIP Reauthorization Act

Additional Resource
CMS FAQ: MIPS Episode-Based Cost Measure Field Test Reports(www.cms.gov)