In today's rapidly evolving transition to value-based care, healthcare providers face the challenge of delivering high-quality care while simultaneously managing costs and improving patient outcomes. Risk adjustment is only one component of this transition. Another important initiative that aims to address these goals is the Quality Payment Program (QPP).
QPP was established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and establishes a model of funding that rewards clinicians who provide high-quality, patient-centered care. QPP has two tracks – Advanced Alternative Payment Models (APMs) and Merit-based Incentive Payment System (MIPS).
Under MIPS, clinicians earn a payment adjustment for Medicare Part B-covered professional services based on CMS’ evaluation of performance across four different performance categories: Quality, Promoting Interoperability, Improvement Activities, and Cost. Each category contributes to a composite performance score (CPS), which is used to determine whether providers receive positive, neutral, or negative payment adjustments. These categories focus on the quality and cost of patient care, improvements to clinical care processes and patient engagement, and use of certified electronic health record technology (CEHRT) to support and promote the electronic exchange of health information.
Successful quality reporting should be a priority for all clinicians. Some points to consider when planning your reporting strategy:
- Quality Improvement: MIPS reporting allows healthcare providers to track and measure the quality of care they deliver to patients. By reporting on various quality measures, providers can identify areas for improvement and implement strategies to enhance patient outcomes.
- Financial Incentives: MIPS reporting is tied to financial incentives or penalties. Eligible clinicians who successfully participate in MIPS can earn positive payment adjustments, while those who do not participate or fail to meet the reporting requirements may face negative payment adjustments.
- Public Reporting: MIPS data is publicly reported on the Physician Compare website, allowing patients to access information about the quality of care provided by different clinicians. This transparency promotes accountability and helps patients make informed decisions about their healthcare providers.
- Compliance: MIPS reporting is a requirement for eligible clinicians under the Medicare Access and CHIP Reauthorization Act (MACRA). Failing to report or meet the reporting requirements can result in financial penalties and potential loss of patients.
- Benchmarking and Comparison: MIPS reporting allows healthcare providers to benchmark their performance against national standards and compare their results with other clinicians. This enables them to identify best practices, learn from top performers, and drive continuous improvement.
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