FPM Offers Tutorial on New Quality Payment Program Rules

Get a Head Start on 2018 MIPS Reporting

December 13, 2017 01:08 pm Sheri Porter

The new year hovers just on the horizon, and with the dawn of 2018 comes a host of freshly minted regulations associated with CMS' Quality Payment Program (QPP). Fortunately, family physicians can turn to a new tutorial from Family Practice Management (FPM) for help navigating the program.

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For a quick review of the essential facts, make time to review "Making Sense of MACRA in 2018: Six Things You Need to Know," published online ahead of the January/February 2018 print issue.

Amy Mullins, M.D., the AAFP's medical director for quality improvement who also serves as the Academy's QPP expert, authored the piece.

In an interview with AAFP News, Mullins pointed out that each year moving forward, CMS will update the rules associated with the Medicare Access and CHIP Reauthorization Act (MACRA), which defines how the QPP is implemented. The agency released an interim final rule(www.gpo.gov) covering the 2018 QPP on Nov. 16.

"We want family physicians to be as informed as possible heading into 2018," said Mullins.

Story Highlights
  • An article published online ahead of the January/February 2018 issue of Family Practice Management aims to help family physicians succeed in the 2018 Quality Payment Program.
  • Author Amy Mullins, M.D., the AAFP's medical director for quality improvement, discusses six points physicians need to understand as they head into 2018.
  • Mullins says CMS has "really turned up the heat for 2018" and that physicians will be expected to engage in more reporting.  

"There is a lot to digest, and the AAFP knows members don't have time to read 600-plus pages of rule updates, so in this FPM article, I'm giving them the high-level changes for 2018," she explained.

The Six Things

In her article, Mullins details where successful participants in the Merit-based Incentive Payment System (MIPS) will focus their time and energy next year. Here is a brief recounting of the pertinent points.

For the 2018 MIPS program, CMS

  • raised the low-volume threshold to exempt more small practices and solo physicians from mandatory participation (from 100 to 200 Medicare patients and from $30,000 to $90,000 in Part B payments),
  • opened the virtual group option to give solo docs and physicians in small practices a better chance at success,
  • increased the weight of the cost category (from zero percent in 2017 to 10 percent of an individual's or group's final score in the coming year),
  • expanded the performance period (from 90 days to a full year of reporting for the cost and quality categories),
  • increased the quality data submission requirements (from 50 percent in 2017 to 60 percent of patients who qualify for a particular measure in 2018), and
  • gave physicians the opportunity to earn bonus points on their final MIPS score based on practice size and patient complexity.

Mullins provides just the right amount of detail on each of these changes to keep readers engaged and informed, so don't pass up this opportunity for quick learning.

She also points out that certain family physicians may have some final tasks to complete related to 2017 reporting.

"It is important to remember that although reporting has begun for 2018, MIPS participants may still submit data for 2017 through March 31, 2018," writes Mullins.

Digging Down With Mullins

Mullins told AAFP News that the road ahead will be challenging. "CMS has really turned up the heat for 2018. Physicians will have to report a lot more and for a lot longer time frame," she said.

Because 2017 was considered a transition year to get physicians familiar with the program, physicians could do as little as report on just one measure for one patient to avoid a negative payment adjustment.

Not so in 2018.

"Physicians need to understand that a full year of quality reporting is required in 2018, and that full year starts on Jan. 1," said Mullins.

Boiled down, that means physicians have to meet a specific threshold -- defined as 60 percent of patients who qualify for a measure -- for the entire year, explained Mullins.

"There will be a whole year of data to look at, but they won't meet the requirement for quality measures unless they meet that 60 percent threshold," she added. By comparison, for full participation status in 2017, CMS required a threshold of just 50 percent of patients eligible for a measure and allowed a 90-day reporting period.

"Physicians engaged in claims reporting really need to pay attention to the more stringent 2018 requirements because they will need to code every encounter so that it flags the system to go ahead and capture the relevant data.

"That data must be grabbed during the billing process; it cannot be collected retrospectively," said Mullins.

Bottom line, begin data collection as early in 2018 as possible.

Mullins offered two final points.

First, she stressed that in general, family physicians have an advantage over physicians in other specialties.

"Many AAFP members will find this reporting process quite familiar if they participated in the Physician Quality Reporting System, leaving them much better prepared and more likely to succeed," noted Mullins.

Lastly, she assured readers that the AAFP is ready, able and willing to help any family physician who desires more in-depth detail on the 2018 changes.

In addition, she pointed out that before the end of year, the AAFP will offer the 2018 MIPS Playbook, a free member resource with a step-by-step guide to meeting all requirements for successful MIPS reporting next year.

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

More From AAFP
MIPS Payment Track: Quality Performance Category

MACRA Ready: The Shift to Value-Based Payment