Quality Payment Program - aanem.org · MIPS –Quality Category – 2017 “Transition Year” •...

Quality PaymentProgram

Millie Suk, JD, MPP

AANEM Health Policy

Director

American Association of Neuromuscular & Electrodiagnostic Medicine - 2016

MACRA: What Is It?

• Medicare Access and CHIP Reauthorization Act

(MACRA) of 2015o Establishes the Quality Payment Program (QPP)

• Clinicians have two tracks to choose from:o The Merit-based Incentive Payment System (MIPS)

o Advanced Alternative Payment Models (APMs)


MIPS: What Is It?

• Majority of clinicians will participate in MIPS for at

least the first couple of years

• MIPS = Modified fee-for-service modelo Combines current Medicare quality programs into a single payment

system

o Clinicians will have payments increased, maintained, or decreased based

on relative performance in four categories


MIPS Performance Categories

• Quality (replaces PQRS and quality portion of VM)

• Advancing Care Information (ACI) (replaces

“Meaningful Use” of EHRs)

• Improvement Activities (IA) (NEW!)

• Cost (replaces the cost component of VM)


MIPS – 2017 Scoring


Quality Category – Scoring


MIPS – Quality Category

• Select 6 quality measures (including 1 outcome

measure) OR 1 specialty measure set (if no

outcome measures in set, report another high

priority measure)o High priority = appropriate use, patient experience, patient safety,

efficiency measures, or care coordination

o Measures pertinent to AANEM members:

https://www.aanem.org/Practice/Medicare/MACRA.

o Different requirements for groups reporting via CMS Web Interface or

those in MIPS APMs


https://www.aanem.org/Practice/Medicare/MACRA


• For group submissions that have ≥ 16 clinicians and

have at least 200 attributed cases, a Readmission

measure will also be automatically calculated

• There are different reporting requirements for

groups reporting via the CMS web interface or

those participating in MIPS APMs.



• Partial credit allowed toward positive payment

adjustments

• No domains or cross-cutting measures

• Bonuses available for reporting through EHR,

qualified registry, QCDR, or web interface


MIPS – 2017 “Transition Year”


MIPS – Quality Category –2017 “Transition Year”

• Test Pace: submit a minimum amount of data for

one measure

• Partial or Full Participation: submit at least 6 quality

measures, including at least one outcome measure


MIPS – Quality Category – Reporting

INDIVIDUAL GROUP

QCDR (Qualified Clinical Data

Registry)

QCDR (Qualified Clinical Data

Registry)

Qualified Registry Qualified Registry

EHR EHR

Claims Administrative Claims

CMS Web Interface (groups of 25+)

CAHPS MIPS Survey


Additional Information

• https://www.aanem.org/Practice/Medicare/MACR

A (AANEM-specific information)

• http://qpp.cms.gov (full list of quality measures and

a tool to help you select pertinent measures)


https://www.aanem.org/Practice/Medicare/MACRA

http://qpp.cms.gov/

Questions?

E-mail: [email protected]

Phone: 507- 288-0100 (ask for Millie or Carrie)


mailto:[email protected]

Quality Payment Program - aanem.org · MIPS –Quality Category – 2017 “Transition Year” •...

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