Welcome

Merit-Based Incentive Payment System (MIPS)

Merit-Based Incentive Payment System (MIPS) is a new program that combines parts of the Physician Quality Reporting System (PQRS), the Value Modifier (VM or Value-based Payment Modifier), the Medicare Electronic Health Record (EHR) incentive program and (PCMH) Practice Centered Medical Home into one single program.

Advanced Alternative Payment Models (Advanced AMPs)

Advanced Alternative Payment Models (Advanced AMPs) are new approaches to paying for medical care through Medicare that incentivize quality and value. Advanced APMs must meet certain criteria as defined by MACRA to qualify.

Comprehensive Primary Care Plus (CPC+)

Two new reimbursement models aiming to stengthen primacry care through a regionally-based multi-payer payment reform and care delivery transformation. CPC+ is a five-year model that will begin in January 2017. Registration deadlines are fast approaching.

• CMS CPC+ Deadline - September 16, 2016
• Medicaid CPC - Deadline varies by state

Meaningful Use

All stages for any 2014 Certified EHR

Significant challenges in successfully attesting to Stage 2 of MU: requires Patient Engagement, Care Coordination and a Health Information Exchange strategy

Focus on aligning quality initiatives to reduce the burden of reporting and streamline the quality improvement efforts. Ex; PQRS/MU/PCMH

MU audit defense preparedness and support: pre and post-payment audits are occurring annually on 5-10% of all healthcare providers who attest to MU

2015: Medicare Physician Fee Schedule payment adjustments begin for not demonstrating MU. Payment adjustments in future years can reach as high as 5%

Physician Quality Reporting System

CMS quality reporting program in which reporting methodology, requirements and specific measures change annually

Incentive payments ending in 2014 but penalties for not reporting continue:

not reporting in 2015=2% Medicare PFS reduction in CY 2017*In addition, Will be subject to the VBM payment adjustment for not reporting PQRS: Solo providers and groups with 2-9 providers=-4% total (2% value modifier penalty + 2% PQRS penalty), Provider groups with 10 or more providers this total non-reporting penalty will be 6% (4% VBM penalty + 2% PQRS penalty)

PQRS data reported in 2015 to be made publically available on all providers via the CMS Physician Compare website

Value Based Modifier

Mandated under the ACA requiring CMS begin applying a value modifier under the Medicare Physician Fee Schedule. In 2015 this applies to all physicians and utilizes PQRS reported quality data and Medicare cost data to determine a provider’s overall value score, referred to as quality tiering. The VBM has the potential to reward high-performing providers with increased payments and reduce payments to low-performing providers, ultimately effecting approximately 900,000 physicians.

Patient Centered Medical Home

The Patient Centered Medical Home is a care delivery model whereby patient treatment is coordinated through their primary care physician to ensure they receive the necessary care when and where they need it, in a manner they can understand.

PCMH initiatives active in Ohio with potential for additional reimbursement for care coordination efforts: http://www.pcpcc.org/initiatives/ohio

Patient Centered Specialty Practice

Like PCMH, this delivery model now incorporates specialty practices committed to access, communication and care coordination to the “neighbors” that surround and inform the medical home and colleagues in primary care.

Practices that become recognized will demonstrate patient-centered care and clinical quality through: streamlined referral processes and care coordination with referring clinicians, timely patient and caregiver-focused care management and continuous clinical quality improvement.