Physicians who participate in Medicare have some new reporting requirements in 2017. Under the Quality Payment Program that launched Jan. 1, Medicare ties payments to the quality and value of care provided. Here’s what you need to know to succeed under the new program.
What’s Changing and Why
Until 2017, the Medicare system paid providers almost solely based on the work required to treat a condition, rather than the end result of the treatment. But amid rising costs, the U.S. health care system has increasingly emphasized value over volume. The Medicare Access and CHIP Reauthorization Act of 2015 passed sweeping reforms to how the Centers for Medicare and Medicaid Services pays physicians.
The new Quality Payment Program offers two options for participation: alternative payment models, which incentivize value, and the new fee-for-service option, called the Merit-Based Incentive Payment System or MIPS. The first option has few viable models for ophthalmologists, so this article focuses on MIPS.
Regardless of the option you choose, CMS will adjust 2019 payments based on 2017 performance.
How Fee for Service Works in 2017
Under MIPS, CMS evaluates physicians based on four categories, each weighted toward a total composite score. Category weights will change as CMS implements the Quality Payment Program, but the agency will use these weights in 2017:
- Quality (previously the Physician Quality Reporting System), 60 percent
- Resource use, 0 percent
- Advancing care information (previously meaningful use) 25 percent
- Improvement activities, 15 percent
Payment Adjustment Options
To help physicians adjust to changes in Medicare, CMS lets you “pick your pace” in 2017. Depending on how much time and effort you want to invest, you can try to receive a bonus or just avoid the 4 percent 2019 penalty.
Here are three ways you could avoid the 2019 penalty with your 2017 performance.
- Submit one quality measure for one patient during the 2017 calendar year: Although this option lets you avoid the penalty, you’ll receive no bonus.
- Submit more than one quality measure or more than one improvement activity at any time during the 2017 calendar year: Using this option, you may qualify for a neutral or small bonus.
Submit at least 90 consecutive days of 2017 data, up to a full year. Your submission must include at least six quality measures, as well as data from advancing care information and practice-improvement activities. This option might help you earn a moderate bonus. At least one of the quality measures must be an outcome or high-priority measure.
There are multiple ways to report for MIPS to CMS. Options include the IRISⓇ Registry, your EHR system, claims and group reporting.
Not every measure supports all four reporting methods, however. For more details, the Academy provides a brief overview for each CMS measure. You can also access a full description of each measure to determine what is best for you and your practice.
Using the IRIS Registry, you can report via manual entry or an EHR system, depending on your vendor. CMS should also certify the IRIS Registry as a qualified registry, qualifying users to earn points toward improvement activities. If you currently use the IRIS, you do not need to re-register.
Group reporting may be best if you are in a multispecialty practice because each subspecialty can select the measures on which they will do well. That way, everyone in the group can benefit.
For a more in-depth look at the four categories of MIPS, be sure to check out the Academy’s free webinar, “Implementing MIPS in Your Practice,” and our detailed guide to reporting MIPS.