Delivery System Reform, Medicare Payment Reform

Delivery System Reform, Medicare Payment Reform

What's the Quality Payment Program?

The Quality Payment Program makes Medicare better by helping you focus on care quality and the one thing that matters most – making patients healthier. The Quality Payment Program ends the Sustainable Growth Rate formula and gives you new tools, models, and resources to help you give your patients the best possible care. You can choose how you want to take part based on your practice size, specialty, location, or patient population.

The Quality Payment Program has 2 tracks you can choose from:

1.      The Merit-based Incentive Payment System (MIPS)

2.      Advanced Alternative Payment Models (APMs)

Virtual Groups

As proposed in the CY 2018 Quality Payment Program proposed rule, if you’re a solo practitioner or a group with 10 or fewer eligible clinicians who participates in the Merit based Incentive Payment System (MIPS) as a virtual group, you’ll need to engage in an election process.  CMS will provide technical assistance, to the extent feasible and appropriate, to help practitioners with the election process.  Looking ahead to 2020, the third year of the Quality Payment Program, CMS hopes to be able to offer you an electronic election process.

The election period for virtual groups to make an election is from October 11, 2017 to December 1, 2017.

Episode-Based Cost Measures 

The eight episode-based cost measures are:

1.      Elective Outpatient Percutaneous Coronary Intervention (PCI)

2.      Knee Arthroplasty

3.      Revascularization for Lower Extremity Chronic Critical Limb Ischemia

4.      Routine Cataract Removal with Intraocular Lens (IOL) Implantation

5.      Screening/Surveillance Colonoscopy

6.      Intracranial Hemorrhage or Cerebral Infarction

7.      Simple Pneumonia with Hospitalization

8.      ST-Elevation Myocardial Infarction (STEMI) with (PCI)

How do episode-based cost measures relate to the Quality Payment Program?

MACRA established a process to enhance the infrastructure for resource use measurement, including for the purpose of developing cost measures for the MIPS cost performance category. MACRA requires cost measures implemented in MIPS to include consideration of patient condition groups and care episode groups (referred to as “episode groups”). As a result, eight episode-based cost measures are currently under development and are being field tested. These 8 measures are being developed with extensive input from 7 Clinical Subcommittees (CS), a Technical Expert Panel, and public comment: • Elective Outpatient Percutaneous Coronary Intervention (PCI) • Knee Arthroplasty • Revascularization for Lower Extremity Chronic Critical Limb Ischemia • Routine Cataract Removal with Intraocular Lens (IOL) Implantation Screening/Surveillance Colonoscopy • Intracranial Hemorrhage or Cerebral Infarction • Simple Pneumonia with Hospitalization • ST-Elevation Myocardial Infarction (STEMI) with PCI.

The eight episode-based measures currently being field tested and are not included in the 2017 or 2018 MIPS performance years.

For more details regarding this article or about our Consulting services , please feel free to contact :

Paul G. Silverio-Benet

305-975-1171

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