As the healthcare industry moves away from fee-for-service and towards pay-for-value, the number of government, insurance, and third-party programs looking to incentivize clinical quality is only going to increase. If you are a practice manager or owner, you will want to be particularly familiar with three of these programs in 2017.
The newest Quality Measurement Program will begin attestation for the 2017 reporting year, created through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This program will offer greater incentives towards improving quality, and on top of successful reporting, will offer bonus payments to practitioners with greater amounts of success.
You are eligible for this program if you are a Physician, Physician’s Assistant, or Nurse Practitioner who also bills for Medicare Part B. MIPS is a new reporting program, but does pull pieces from Meaningful Use and PQRS; MIPS is broken down to 3 weighted categories for the 2017 reporting year:
- Quality (Quality Measures)– 60%
- Advancing Care Information (Formerly Meaningful Use) – 25%
- Improvement Activities - 15%
Comprehensive Primary Care Plus (CPC +) begins its first round of reporting in January 2017, round 2 will start January 1, 2018. CPC+ is a private-public partnership between regional payers and CMS to redesign the payment model and provide providers with the financial resources to deliver a primary care home model. Currently CPC + is supported in 14 regions, but 10 more regions will be open for application in the summer of 2017.
You are eligible to apply for participation in CPC + if you bill Medicare Part B and can be accepted through the application program. To reach their goal of a healthier patient population, the program alters the payment plan by separating the payment into three different allocations: Care Management Fee, Performance-Based Incentive Payments, and Medicare Physician Fee Schedule.
Patient-Centered Medical Home (PCMH) recognition is offered by the National Committee for Quality Assurance (NCQA) and is meant to encourage a setting for partnerships between practitioners and their patients.
PCMH is a recognition status given by the National Committee for Quality Assurance (NCQA) and awarded on three different levels, with Level 1 being the completion of the most basic requirements and Level 3 be the most advanced requirements. The PCMH program doesn’t have a direct financial incentive through reporting, but health plans and CMS may recognize your status with improved reimbursement.
In addition to those incentives, you may be eligible for reporting exemptions in the MIPS program if you are successfully recognized as a PCMH.
Many quality reporting programs can be integrated into your current clinical workflows.
For more information on these programs, who is eligible and exempt, and integrating your workflows, attend my session on Quality Measurement Programs at eMDs UCS 2017! You can register now at conference.e-mds.com.
*Current Regions for CPC+: Arkansas, Colorado, Hawaii, Greater Kansas City Region of Kansas and Missouri, Michigan, Montana, North Hudson-Capital Region of New York, New Jersey, Ohio and Northern Kentucky Region, Oklahoma, Oregon, Greater Philadelphia Region of Pennsylvania, Rhode Island, and Tennessee.