CMS Quality Payment Program

On October 14, 2016, the Department of Health and Human Services (HHS) issued its final rule with comment period implementing the Quality Payment Program that is part of the Medicare Access and CHIP Re authorization Act of 2015 (MACRA).

The Quality Payment Program improves Medicare by helping you focus on care quality and the one thing that matters most — making patients healthier. The Quality Payment Program has two tracks you can choose from:

APMS-Advanced Alternative Payment ModelsANDMIPS – Merit-based Incentive Payment SystemsA4 falls under this track in the quality payment program

In MIPS, you earn a payment adjustment based on evidence-based and practice-specific quality data. Based on your performance in 2017, you will see a positive, neutral, or negative adjustment of up to 4% to your Medicare payments for covered professional services furnished in 2019. This adjustment percentage grows to a potential of 9% in 2022 and beyond.

There are 4 Performance Categories for MIPS:

• Quality – Replaces PQRS (Physician Quality Reporting System)

• Improvement Activities – New for 2017

• Advanced Care Information – Replaces the Medicare EHR incentive program (also known as Meaningful Use)

• Cost – Replaces Value Based Modifier-will start in 2018

A4 is currently reporting their MIPS Performance Categories for 2017 through the POM ACO * (Physician Organization of Michigan Accountable Care Organization) which is a Medicare Shared Savings Program. A4 has been participating in the POM ACO for a few years now and has been granted some shared savings in the past.

*Accountable care organizations (ACOs) are groups of doctors, hospitals and other health care providers who join together to coordinate care for patients. The purpose of an ACO is to reduce the cost of care by eliminating duplication of efforts and increasing the quality of services.