QPP Basics

Value-Based Care Has Arrived.

The change from rewarding value over volume is one that has been years in the making. Following passage the Affordable Care Act, the federal government began transitioning from rewarding for quantity (fee-for-service) to rewarding for quality and cost. This goal is summed up by what the Centers for Medicare & Medicaid calls the Triple Aim — better health, better care and lower costs.

Get Ready for Change.

QPP is more than physician reimbursement — it will drive the future of the U.S. healthcare system and a new generation of technology to support it. The ultimate goal is to move toward a value-based healthcare system that ensures high-quality, affordable healthcare.

There’s a Learning Curve.

QPP streamlines current CMS quality reporting programs (PQRS, VM & MU) and separates them into two tracks:

  1. Merit-Based Incentive Payment System (MIPS)
  2. Alternative Payment Models (APMs)

Most Providers Are Affected.

Unlike previous reporting initiatives, MACRA does not offer the option for providers to opt out of reporting by paying a penalty. This means any provider accepting Medicare Part B patients*, including physicians, physician assistants, nurse practitioners, clinical nurse specialists and nurse anesthetists, are required to report one of the two tracks in 2017.

 *For now, only physician offices — not hospitals — are governed by MACRA rules. In addition, this program only applies to payments physicians receive from Medicare. Medicaid is not included.

Penalties Are at Stake.

In the proposed rule, CMS estimates approximately half of all MIPS-eligible clinicians will earn an incentive for the first performance year, and the other half will be assessed a penalty.

Scores are Public.

All participant performances will be publicly reported on CMS’ Physician Compare website.

It’s Go Time.

Providers shouldn’t let the 2019 payment adjustment date give a false sense of security. The data used to pay providers in 2019 is derived from performance in 2017 (right now). Providers have big decisions to make, and Telligen is here to help.