The much-anticipated transition from a fee-for-service health care system to a value-based care model is well underway. Last year (2018) was the first full participation year for the Centers for Medicare & Medicaid Services (CMS) Quality Payment Program (QPP), which consists of two payment tracks in accordance with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Because complying with MACRA may be overwhelming for many physicians, CMS has invested in free, nationwide technical assistance programs. The CMS technical assistance initiative is designed to help clinicians successfully participate in the QPP through direct, customized support, a CMS spokesperson explains.
What many providers may not realize is that QPP is not something they sign up for—if your practice treats Medicare patients, you are automatically participating. “CMS has designated where you’re participating, based on how you see patients,” explains Amy Mullins, MD, the medical director for quality improvement at the American Academy of Family Physicians.
Two QPP payment tracks are available: the Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Model (APM). Most providers have been automatically assigned to participate in MIPS, which adjusts payment based on performance in four categories. Participants in the APM track receive higher reimbursement rates and bonuses but qualify only if they are a part of the CMS Innovation Model, Medicare Shared Savings Program, or a specific demonstration program.
Clinicians can check their assigned QPP track by entering their National Provider Identifier number on CMS’ QPP website (https://qpp.cms.gov/participation-lookup).
Donna Cohen, RN, the deputy director of population health for Alliant Health Solutions, a CMS technical assistance subcontractor, helps providers and practice managers navigate QPP requirements through webinars and one-on-one assistance. Cohen also assists practices with choosing the reporting mechanisms and quality measures that are best suited to their patient population.
Alliant Health Solutions is the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for North Carolina and Georgia. The QIN-QIO program—designated to support large practices with more than 15 clinicians—is one of the four technical assistance programs funded by CMS to help providers navigate its new payment structure. Cohen works closely with clinicians to track their activities throughout the year and provides them with checklists and time frames for reporting measures. “We developed a lot of tools for [providers] to use,” she says. “We work with them to say, ‘What have you done so far?’”
Providers who didn’t submit reporting measures in 2017 may experience a 4 percent reimbursement cut in 2019. Those who did not participate in 2018 are subject to a 5 percent reimbursement cut in 2020. “Physicians should know that QPP is in effect,” Mullins says.
The complexity of MACRA and QPP can’t be overstated, as many experts acknowledge. “The QPP is thousands of pages, very complicated, and changes frequently,” Mullins adds.
Regardless of a practice’s fluency with QPP, providers can benefit from the resources provided by the technical assistance initiative. “Because the MACRA regulations change every year, it’s challenging to keep up with. Because of staff turnover, it’s challenging to have consistency in training staff,” Cohen explains.
CMS is committed to providing a high level of support to all physicians nationwide and engages in what it calls the “no wrong door” approach. Regardless of how or where a clinician initially reaches out for support, its networks will always answer clinicians’ initial questions and then connect them with the right form of support within 24 hours. CMS encourages all eligible clinicians to access the QPP Service Center online (qpp.cms.gov) or by calling 866-288-8292
CMS has created and funded four technical assistance programs to ensure that providers can fully participate in the QPP.
Quality Innovation Network-Quality Improvement Organization (QIN-QIO). Supports clinicians in large practices (more than 15 clinicians) in meeting MIPS requirements through customized technical assistance. Provides skills for transforming practices and developing innovative approaches to quality improvement through data-driven initiatives that improve patient safety, coordinate better post-hospital care, and enhance clinical quality.
Quality Payment Program-Small, Underserved, and Rural Support (QPP-SURS). Provides guidance and direct technical assistance to clinicians in solo or small practices (15 or fewer clinicians), particularly those in rural and underserved areas, to promote successful health information technology adoption, optimization, and delivery system reform activities. Also assists practices with reporting under MIPS.
Alternative Payment Model Learning Systems. Provides APM participants with specialized information to increase success in the Advanced APM (AAPM) track. It also helps APMs that are not AAPMs understand the benefits of MIPS APMs.
Transforming Clinical Practice initiative (TCPi). Designed to help clinicians expand their quality improvement capacity, engage in greater peer-to-peer learning, and use health data to identify gaps and target intervention needs. Interested participants must enroll with a Practice Transformation Network—a peer-based learning network—to receive this assistance.