The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established a change from a fee-for-service (FFS) Medicare payment schedule to one more focused on outcomes-based payments. Payment to eligible professionals will be based on their composite performance score within the Merit-Based Incentive Payment System (MIPS) unless they are participants in an Alternative Payment Model (APM), are newly enrolled in Medicare, or their total Medicare claims are below the low-volume threshold as defined by CMS. Individual clinicians as well as those in small and large groups have faced challenges with an increase in physician burden learning a new payment model and implementing new quality measures and improvement activities. Clinicians required assistance with understanding the new program requirements and what steps needed to be taken to be successful.
MACRA established a Direct Technical Assistance program through the QIN-QIO program to assist large clinician groups of 15 or more. Similarly, a separate program was established to assist individuals and small clinician groups referred to as the Quality Payment Program Small/Underserved/and Rural Support (QPP-SURS) program. This technical assistance provides education and resources for understanding the newly implemented Quality Payment Program, which quality measures and improvement activities are most applicable to clinicians in internal medicine and specialty practices, and which submission method would be used to report. Small practices have faced challenges in adopting HIT technology and need additional assistance implementing MIPS requirements for team-based care, interoperability, population health, and referrals. Alternative Payment Models (APMs) is an additional payment approach that provides added incentives to eligible clinicians. Qualidigm is working with practices to transition them from the MIPS track to MIPS APMs or Advanced APMs to obtain the added incentives. Qualidigm utilizes direct technical assistance strategies to provide education and solutions for eligible clinicians to be successful in MIPS and APM reporting.
The Quality Payment Program saw over a 90% participation rate in the first reporting year, 2017. Many eligible clinicians were able to avoid the penalty and will even see a positive payment adjustment in 2019. The direct technical assistance offered to eligible clinicians allowed successful reporting and an overwhelming participation rate for the introductory year of a new CMS implemented payment program.