The transition from PQRS to MIPS/QPP

The 2017 final rule that will implement the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program (QPP) as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) has been released. This program is the latest in a series of steps that CMS has taken to incentivize quality healthcare over fee for service volume. One of the major provisions of the QPP consolidates the current Medicare programs, PQRS, Value-Based Payment Modifier, and Meaningful Use, into a single reporting program.

Alpha II has been involved with the Physician Quality Reporting System (PQRS) since 2007, when it was an initiative known as the Physician Quality Reporting Initiative (PQRI). Since 2014, the Alpha II Qualified Registry has assisted and enabled thousands of providers meet their PQRS reporting requirements. Now, and still mirroring the CMS focus on quality, Alpha II is shifting effort to the new QPP for the 2017 reporting year.

Although the QPP begins January 1, 2017, this will be a transition year with less financial risk for eligible clinicians in at least the first year of the program.

The Quality Payment Program has two tracks you can choose from:

  • The Merit-based Incentive Payment System (MIPS)
    • You may earn a performance-based payment adjustment through MIPS.
  • Advanced Alternative Payment Models (APMs)
    • If you decide to take part in an Advanced APM, you may earn a Medicare incentive payment for participating in an innovative payment model.

While the 2017 QPP offers two tracks—MIPS and APM—most providers will report under the MIPS track due to cost or the investment of APMs. As a qualified Registry, Alpha II stands ready to bring our extensive quality expertise to our partners for the transition to MIPS quality reporting.

How will the Quality Payment Program change my Medicare payments?

Under the MIPS track of the Quality Payment Program for 2017 you have four choices for the data you wish to submit. Your decision for 2017 will result in your calendar year 2019 Medicare payments being adjusted up, down, or not at all. The information provided below is only relevant for the 2019 payment year. CMS will provide additional information on payment adjustments for 2020 and beyond beginning in 2018.

Pick your pace in MIPS

Test participation: Either 1 quality measure or 1 improvement activity or 4 or 5 required advancing care information measures.

Note: Improvement activities and advancing care information measures are different from quality measures.

Groups using the web interface: Report 15 quality measures for a full year.

High-priority measure: Outcome measure, appropriate use measure, patient experience, patient safety, efficiency measures, or care coordination.

For a list of high-priority measures, see files in MIPS Measures

Specialty-specific measure set: Not all measures in each specialty measure set will be applicable to all clinicians in a given specialty. If the set includes fewer than six applicable measures, the eligible clinician should only report the measures that are applicable.

For a list of measures for each specialty-specific measure set, see files in MIPS Measures

The MIPS data aggregation is designed around the four categories of clinical care shown below. Providers will receive a composite score based on performance across all the categories, where the weight for each category varies.

Category Weight Percentages

At Alpha II, we know how confusing each year’s fast-paced changes to the quality reporting programs has been and how much time trying to understand it on your own takes away from your practice. Our expert staff works hard to make the task of quality reporting easier for your practice to accomplish by providing insight on accuracy from the very first data submission.

For information on the Alpha II Registry and its seamless integration, please visit Registry Solutions, call (800) 825-7421, or email us at registry@alphaii.com.

Alpha II understands how overwhelming and complex these new programs can be. Therefore, we have developed “What is QPP?” – a more detailed overview of the program.