For the record - AAMA · 2017-06-27 · (Children’s Health Insurance Program) Reauthorization Act of 2015 (MACRA). Under MACRA, performance measure - ments for new payment models

12 JulAug 2017 | CMA Today

For the record

B y M a r k H a r r i s

This year marks the introduction of a new stage in the evolving world of Medicare payment reform. On October 14, 2016, the Centers for Medicare & Medicaid Services

(CMS) issued the final rule for the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act

of 2015 (MACRA). Under MACRA, performance measure-ments for new payment models began in 2017.1

What is the significance of MACRA? First, the new payment system replaces Medicare’s old sustain-

able growth rate (SGR) formula used to manage health care spending. Also, MACRA represents a

move away from the traditional fee-for-service payment model toward a more value-based

system designed to reward the quality of care provided over the quantity of services

delivered. A crucial component of this drive toward value is Medicare’s new

Quality Payment Program (QPP), which offers providers new tools

and resources for promoting best care practices.1

Naturally, to improve the quality of care, physicians

need knowledge of what treatments work and

what ones do not. As Medicare moves

toward more value-based

reimburse-ment, one

resource in the

CMA Today | JulAug 2017 13

QPP tool kit will be the qualified clinical data registry (QCDR), a unique new reporting mechanism designed to enhance data collec-tion in specialty areas of medicine. Medicare hopes QCDRs will become increasingly valued tools for medical specialty groups to identify and improve best practices in their respective fields of care.

The road to reformUnder MACRA, the QPP and resources such as the QCDR are not designed to be quick fixes in the payment system. In fact, experts say the transition from fee-for-service to more value-based models of care is reform long in the making. “MACRA did not just come out of the blue in 2015,” remarks Pamela Ballou-Nelson, PhD, MSPH, RN, a senior consultant for the Medical Group Management Association (MGMA) based in Englewood, Colorado. “If you’re a historian of health care, you know we have been walking toward operationalizing value-based models of care for some time now. In fact, this transformation in our health care system began with the 1994 report from the Institute of Medicine (IOM), America’s Health in Transition: Protecting and Improving Quality.2 This was the first phase of the quality initiative when we began to document the pervasive nature of the nation’s overall health care quality problem. The conclusion at the time was that the burden of harm conveyed by the collective impact of our health care quality problem was staggering.”

Fast forward to 2017. Value-based care models oriented toward measuring and

rewarding quality have become an all-stake-holder project, says Dr. Ballou-Nelson.

These models are already making an

Qualified clinical data registries

take the measure of data

Logging onUnfortunately, Medicare reimbursement issues can be incredibly complicated to understand, Stryker acknowledges. Indeed, one recent survey found widespread uncer-tainty among medical practices about the impact of payment reform and the require-ments following the launch of MACRA. More than 40 percent of those surveyed acknowledged they were unsure if they understood how MACRA or the QPP works.3

So, where to start? What should health care providers know about the QPP and reporting resources such as the QCDR? First, there are two new payment tracks under the QPP in which providers can participate4:

• Merit-Based Incentive Payment System (MIPS)

• Advanced Alternative Payment Models (APMs)

Starting in 2017, the QPP combines Medicare’s meaningful use (MU), Physician Quality Reporting System (PQRS), and Physician Value-Based Payment Modifier (VM) programs into one MIPS score to streamline reporting. Using this composite MIPS performance score, participating clini-cians may receive either a payment bonus, penalty, or no payment adjustment.5 Several health professionals are eligible to participate in MIPS4:

• Physicians

• Nurse practitioners

• Physician assistants

• Clinical nurse specialists

• Certified registered nurse anesthetists

Eligible professionals can also participate either as individuals or as members of a group practice.

Notably, there are four reporting categories that contribute to the annual MIPS score5,6:

1. Quality

2. Meaningful use of certified electronic health record technology (CEHRT), or advancing care information

impact in Medicare’s new payment system,

and in the next few years that influence

should expand to affect the world of com-

mercial insurance as well, she notes.

Indeed, as most industry observers

acknowledge, on many issues Medicare

tends to set the stage for what is to come

throughout the health care system. “Where

Medicare goes, the commercial payers are not

far behind,” remarks Carol Stryker, MBA, a

columnist for Physicians Practice and prin-

cipal of Symbiotic Solutions in Houston.

“The Medicare fee schedule is pretty much

the baseline for everybody else. That’s why

it’s really important to pay attention to what

Medicare is doing.”


SGR | Sustainable growth rateThe SGR formula was used to manage health care spend-ing by Medicare on physician services

Fee-for-service model of carePhysicians and other health care providers are paid for each service performed, such as tests and office visits.

MACRA | Medicare Access and CHIP Reauthorization ActMACRA establishes a new way to pay physicians who treat Medicare patients.

Value-based model of careHealth care providers are rewarded with incentive pay-ments for the quality of care they provide.

QPP | Quality Payment Program Offers two payment tracks:• APMs | Advanced Alternative Payment Models• MIPS | Merit-based Incentive Payment System

QCDR | Qualified clinical data registryProvides reporting mechanism to enhance data collection in specialty areas of medicine.

MEDICARE PAYMENT REFORM

Medicare QCDR

3. Clinical practice improvement activi-

ties (CPIA), or improvement activities

4. Resource use, or cost

Under this system, MIPS payment adjust-

ments apply to Medicare Part B two years

after the performance year for which data is

collected. Thus, the data collected by indi-

vidual clinicians and group practices in

the performance year 2017 will be applied

to payment adjustments in 2019. As part

of the first-year program rollout, the cost

category will be calculated for 2017 but not

used to determine any payment adjustments

until 2018.5

The reporting options under the

quality category, which constitutes more

than half the composite score, are basi-

cally the same as under the older PQRS,

which is now being phased out. For both

individual clinicians and groups, these

include the option to report using a qual-

ified registry, electronic health record

(EHR), QCDR, or through claims process-

ing. Group participants can also report

through a Web interface or a Consumer

Assessment of Healthcare Providers and

Systems (CAHPS) survey.5

The other track for participation is that

of the APMs. Providers who participate in

an Advanced APM through Medicare Part

B will earn incentive payments for their

participation. As such, providers who in

2017 receive 25 percent of their Medicare

payments or see 20 percent of Medicare

patients through an Advanced APM can

expect to earn a 5 percent incentive pay-

ment in 2019.4

The more complex Advanced APM

track is designed for practices making more

concerted efforts to improve patient care

and take on risk related to their patients’

outcomes.7 An Advanced APM can apply to

specific clinical conditions, a care episode, or

a population.7 At this early juncture in the

QPP, approximately 85 percent of eligible

professionals are expected to choose the

MIPS route over the APM track, says Dr.

Richardson.

Measure upThis is where the QCDR enters the picture. As a component of these larger payment reforms, the QCDR is designed to help clinicians enhance their data collection methods and analytics to promote more patient-centered, cost-sensitive quality care. Typically, the QCDR is organized through a specialty society, certification board, or regional health collaborative. Notably, QCDRs are distinct from other qualified registries in that participants have the option to report both MIPS and non-MIPs performance measures.8,9

For many industry observers, the QCDR model offers the promise of both a more streamlined reporting system and enhanced data analysis. “The challenge is to coordi-nate care across the continuum so that we have fewer mistakes, better outcomes, and avoid the duplication [of services] and costly procedures that can happen when providers are not coordinating care,” says Dr. Ballou-Nelson. “With a QCDR that can focus in on geographic data, or certain disease entities and outcomes, we can begin to better piece together what are our best practices. This is the promise of QCDRs as we move forward to a transformed health care system.”

In an interview for ReachMD, a pod-cast series from the American Medical Association (AMA), Koryn Rubin, the assis-tant director of federal affairs at AMA, notes that QCDR use is “heavily incentivized and encouraged” within the QPP. “CMS provides several ways for physicians to utilize a QCDR to satisfy the QPP,” says Rubin. “Primarily where you would receive the most credit for satisfying requirements is through the quality category, so a physician or practice can meet the quality category by utilizing a QCDR to report on quality measures. You also can receive credit, and depending on the activities you choose, you can satisfy all the improvement category requirements. You also can receive some bonus points in [the] advancing care information category if you report the optional clinical data registry measure, and you would do that by utilizing a QCDR.”10

There are other significant changes in the transition to QCDR use, reports Rubin. As noted, the PQRS program for quality reporting now transitions into the QPP, while Medicare has also lowered the reporting requirements from nine to six measures. Notably, among the six mea-sures, one is expected to be an outcome measure.10


What’s a QCDR? A qualified clinical data registry (QCDR) is an entity that collects clini-cal data on behalf of clinicians for data submission and is approved by the Centers for Medicare & Medicaid Services (CMS). Examples include, but are not limited to, regional col-laboratives and specialty societies. Also, QCDRs cannot be owned or managed by an individual, locally owned, specialty group.9 The QCDR reporting option is different from a qualified registry because it is not limited to mea-sures within the Quality Payment Program (QPP). The QCDR can host CMS-approved, non-Merit-Based Incentive Payment System (MIPS) measures for reporting. A QCDR may submit measures from one or more of the following categories, with a maximum of 30 non-MIPS measures allowed per QCDR9:

• Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS), which must be reported via a CAHPS-certified vendor

• National Quality Forum (NQF) endorsed measures

• Current 2017 MIPS measures

• Measures used by boards or specialty societies

• Measures used by regional quality collaborations

• Other approved CMS measures

“If there are no outcome measures

within that QCDR, then you would report

on high-priority measures,” says Rubin.

“CMS defines a high-priority measure as a

measure that covers appropriate use, patient

safety, care coordination, or patient experi-

ence. Also, if you’re going for or trying to

obtain an incentive when you report in 2017

and not just avoid a penalty, the measures

that you report on must be reported on 50

percent of applicable patients.”10

A painless process One group using a QCDR is the American Society of Anesthesiologists (ASA). The ASA-affiliated Anesthesia Quality Institute (AQI) sponsors the National Anesthesia Clinical Outcomes Registry (NACOR), a CMS-approved QCDR in this specialty area.11

The Anesthesiology Specialty-Specific Measure Set identifies nine CMS-approved MIPS measures, including the following12:

• Documenting current medications in the medical record

• Preventive care and screening for high blood pressure and follow-up

• Anesthesiology smoking abstinence

• Perioperative temperature manage-ment

Participants in the QCDR can also select measures from the broader, nonspecialty set of MIPS measures.12

If fewer than six measures apply to a clinician, the clinician should then report on all applicable measures, including one outcome measure, according to the instruc-tions for NACOR participants from ASA. In the absence of the latter, clinicians must report a high priority measure, which applies to such categories as the following12:

• Appropriate use

• Patient safety

• Efficiency

• Patient experience

• Care coordination

Clinicians must also report on at least 50 percent of their patients to whom the mea-sure applies for all payers (Medicare and non-Medicare).

For quality measurement experts, the use of QCDRs in specialty areas, such as anesthesiology, is a promising development. “In the coming years, QCDRs will be allowed to define specific CPIAs [clinical practice improvement activities] for clinicians or groups through an established approval process,” says Emily Richardson, MD, an

anesthesiologist and chief quality officer of Encompass Medical Partners in Fort Collins, Colorado, in a commentary writ-ten just prior to adoption of MACRA’s final rule. “Additional measures and activities captured by QCDRs could enable specialty clinicians or groups to capture and report on more meaningful activities. In the proposed rule, CMS describes a call for measures and activities processes where MIPS-eligible clinicians, groups, and other stakeholders may recommend activities for potential inclusion in the CPIA Inventory. The use of QCDRs also allows for ongoing performance feedback and the implementation of con-tinuous process improvements, ultimately enabling us to reach our goal of providing better patient care.”13

The measurement process itself can facilitate a more engaged and productive quality improvement culture, notes Dr. Richardson, who is also chairperson of the Practice Quality Improvement Committee for the AQI. As an example, she cites the impact of the specialty-specific MIPS mea-sure for perioperative temperature manage-ment in anesthesiology.

“It is well known in anesthesia and surgery that when patients get cold they are more likely to have complications,” observes Dr. Richardson. “This is because when people are under anesthesia they essentially lose heat very rapidly. And when they become cold, there are physi-ologic changes that can occur. . . . That’s why it makes sense for anesthesiologists to measure how we are doing at keeping the patient warm.”

With the QCDR, physicians are better able to measure how patients are doing under different providers, says Dr. Richardson. “Interestingly, the first iteration of the measure for temperature manage-ment asked whether the patient was warm at the end of the case or in the recovery room. If they were, wonderful. If they weren’t, then the question became: Did you at least try to warm them? If you tried to warm them, but they were still cold, you still kind of ‘passed.’ But last year this measure was changed,”


Prepare your practiceWhether your practice ultimately participates in an Advanced Alternative Payment Model (APM) or the Merit-Based Incentive Payment System (MIPS), taking action in the following areas can prepare your practice for future effectiveness as noted by the American Medical Association:

• Determine whether you have $30,000 or less in Medicare charges OR 100 or fewer Medicare patients annually. If so, you are exempt from MIPS partici-pation. . . .

• If you are not already participat-ing in a qualified clinical data registry (QCDR), contact your specialty society about partici-pating in theirs—data registries can streamline reporting and assist with MIPS performance scoring.

• Determine whether your practice meets the requirements for small, rural, health-professional-short-age area or non-patient-facing physician accommodations.

• Determine whether you want to participate as an individual or group. If participating and report-ing as a group, all physicians in the group must report on the same measures across all four categories.17

Medicare QCDR

she points out. “That get-out-of-jail-free card—‘I tried to warm them’—was essen-tially taken away. Now, that’s no longer good enough. Instead, there is an actual outcome measure that asks: Was the patient warm, yes or no? And if they weren’t warm, was there some medical reason to explain why? If not, then that’s a poor score.”

Often, Dr. Richardson notes, behaviors also change when physicians know they are being measured. “With temperature management five years ago, someone might have said, ‘Well, my patient’s cold. I tried, [but] so what?’ Now, they’re more likely to say, ‘Gosh, they’re cold. I’ll see if I can warm them up by the end of this case.’”

More generally, measurement activi-ties can prompt clinicians to become better focused on how they are doing and to think more critically about what constitutes best practices in their work. As Dr. Richardson notes, “When you talk to individual clinicians, they often don’t necessarily see any problems with their work. They think they’re doing great. But with better data and analytics, I think the first thing we’re going to see is that we actually do have some deficiencies. This should help providers open their eyes a little more. Once we have the sophis-tication with registries, we’re going to be better able to say, ‘OK, we found a


MIPSMerit-Based Incentive Payment System

Reporting categories1. Quality2. Advancing care information3. Improvement activities4. Cost

MIPS performance results (incorporates elements of the following)

MU: Meaningful UsePQRS: Physician Quality Reporting SystemVM: Physician Value-Based Payment Modifier

MIPS• Payment bonus• Penalty• No payment adjustment

Advanced APMsAdvanced Alternative Payment Models

Advanced APMs• More complex track

• Providers earn incentive payments for their participation

• Designed for practices making more concert-ed efforts to improve patient care and take on risk related to their patients’ outcomes.7

• Can apply to specific clinical conditions, a care episode, or a population.7

QUALITY PAYMENT PROGRAM

Two payment tracks

deficiency, we’re not particularly good at

this type of measure, and now we have

an opportunity to improve.’”

Body of research Another informative example of a QCDR

in operation is the Diabetes Collaborative

Registry. The registry represents a unique

interdisciplinary data-gathering initia-

tive led by several entities, including the

following14:

• The American College of Cardiology

• The American Diabetes Association

• The American College of Physicians


• The American Association of Clinical Endocrinologists

• Joslin Diabetes Center

As a chronic condition, diabetes is frequently associated with multiple comorbidities and complications that require cross-specialty management. Accordingly, the Diabetes Collaborative Registry collects data from primary care physicians, endocrinologists, cardiologists, and other providers treating diabetes patients.14

The registry uses the American College of Cardiology’s Pinnacle Registry, a large ambulatory cardiovascular regis-try with clinical data on a large pool of diabetes patients. The data collection is based on a series of national performance measures and metrics for diabetes, car-diovascular disease, and cardiometabolic disease management. Additional data come from EHRs made available by par-ticipating providers.14

Participating providers are given “easy-to-interpret benchmark reports that validate

the quality care . . . and pinpoint oppor-tunities for improvement.”14 There are 13 measures in the diabetes registry to address a range of medical issues, including15:

• The percentage of patients with poor control of hemoglobin A1c (i.e., blood sugar)

• Nephropathy screening

• Counseling on dietary intake

• Counseling on physical activity

• Tobacco use cessation counseling

• The percentage of patients who received foot and eye exams

• The percentage of patients with peripheral artery disease who were offered statin medications to treat blood cholesterol levels

As the first initiative to gather key clini-cal data across multiple specialty areas, industry observers are hopeful about the registry’s future impact on diabetes care. “The Diabetes Collaborative Registry is a real-world collaboration that looks at diabetes across specialty and primary care lines,” says Dr. Ballou-Nelson. “In my view, it’s a great example of how we can establish our best practices. When we can state that 3,000 physicians do it this way and this is the outcome, any physician will then be able to ask: How do I benchmark and compare with these practices?”

Dr. Ballou-Nelson is particularly hope-ful the enhanced knowledge made available through QCDR registries will increasingly resonate with physicians. “The advantage of the QCDR is that it integrates improvement activity, technology, and best practices for a particular type of condition or entity with outcomes and costs. I think physicians will recognize and identify with QCDRs much more quickly and see the big picture more completely since they’re not just looking at isolated quality measures.”

Indeed, the potential of the QCDR is essentially found in the greater meaning it can bring to physicians about the data they collect and the work they do, says Dr. Ballou-

Nelson. As an example of this, she shares an observation from her recent consulting work for MGMA.

“I was working with a group of endo-crinology specialists who were not very interested in Medicare’s meaningful use program or the Physician Quality Reporting System [PQRS],” she says. “They partici-pated in these programs, but didn’t really see the bigger picture. Then along came MACRA’s QPP.

“Initially, they were even less inter-ested, and even a little bummed out, about what they thought they were now going to have to do. But then, lo and behold, one of the physicians read an article about the Diabetes Collaborative Registry as the first global, cross-specialty, clinical registry designed to track and improve the quality of diabetes and metabolic care across the primary care and specialty care continuum,” she continues.

“Well, all of a sudden, this physician group had interest. They saw that these were physicians putting this collaborative registry together, that they were talking about integrating care and the health of the [patient] population across the continuum. They now understood that this is what the QPP is all about,” she explains. “This physi-cian group hadn’t been able to make sense out of the individual quality measures, but the Diabetes Collaborative Registry put the whole issue together. Thanks to the registry, it made sense to them.”

Medicare made easierTo many observers, Medicare’s payment system appears to be an imposing labyrinth of regulations, requirements, and programs. Admittedly, this is not always an unfair per-ception. To introduce major changes into such a complex system might understand-ably stir up even more anxiety or uncertainty among providers concerned with keeping their footing on Medicare’s shifting payment landscapes.

But Medicare’s payment reforms are not intended to further complicate life for providers or patients. In fact, one goal of

Help centerThe Quality Payment Program (QPP) website offers a resource library that includes a variety of informational sources18:

• Official rule information

• MACRA information

• Video library

• Webinars and educational pro-grams

• Downloadable documents for cli-nicians, registries, qualified clini-cal data registries, and electronic health record (EHR) vendors

• QPP Service Center

o 866/288-8292

o TTY: 877/715-6222

o Available Monday to Friday, 8 am–8 pm EST

Medicare QCDR

MACRA and the QPP is to establish a more streamlined and meaningful user experi-ence, one that offers providers more flexible options in how they may choose to partici-pate. In this spirit, CMS has made available four flexible first-year reporting options for 2017 to help ease clinicians’ transition into the new payment system.16 Meanwhile, QCDR use is expected to expand. As of late 2016, some reports indicate approximately 70 QCDRs are now in various stages of development.10

While the MACRA-initiated QPP in all its parts is complex, Dr. Richardson says CMS has spent considerable time listening to the provider community’s concerns to make the program less burdensome. “The QPP is a tough program to understand, but I think when we’re able to present it in a straightforward way clinicians can see that it’s actually doable,” she says. “I won’t say it is less complex than the earlier programs, but CMS has at least tried to align the reporting methods with the goals of what’s important to providers.”

Accordingly, Dr. Richardson is also optimistic that as QCDRs become more established, the resulting enhanced data collection will be increasingly helpful to clinicians. “Ideally, the goal is to have valid, robust registry data that physicians can use to improve the care they deliver,” she says. “The nice thing about QCDRs is that providers can now essentially report their data to one place. There is also much more flexibility. Unlike the qualified registries, QCDRs are not limited to MIPS measures. We also have more measures to choose from.

“Of course, it’s still a work in progress,” notes Dr. Richardson. “The registries are still growing. There remain difficulties in the vendor world, in terms of making registries useful and functional for clinicians. So, yes, we do need to have good registries and good ways to collect data. We need to have accu-rate reporting systems. Again, these are all in a growing phase. But once we have that infrastructure in place . . . I think we’ll have a wonderful resource to identify problems and improve care.”

For now, clinicians, practice managers, and other professionals involved in data col-lection should take the time to familiarize themselves with the basics of how the QPP works. “Quality reporting is certainly not going away,” cautions Stryker. “But managers should know these programs are not always as hard to implement as they seem to be. It’s just important that whoever is responsible for making it happen in the practice gets a good foundational understanding of what Medicare, and by extension, the other [insur-ance] carriers, are trying to accomplish. To the extent possible, my advice is to go to the primary sources. Study the Medicare website, [and] read and pay attention to the details. You can also ask your billing companies to help. It’s to their advantage for a practice to be compliant with quality requirements and quality reporting measures.”

All in all, the QPP and the QCDR reporting model represent a long-term opportunity to enhance data collection toward the goal of establishing more con-sistent best practices. “Our goal now is to begin to try to better standardize our care,” concludes Dr. Ballou-Nelson. “In the past, we have not done a good job in identifying best practices in mapping care across the continuum. This is because we really haven’t had that integrated data to be able to say this is working [and] this is not working. We need current integrated data to do that. This is the beauty of the QCDR.” ✦

References 1. Rappleye E. CMS releases MACRA final rule: 10

things to know. Becker’s Hospital CFO. http://www .beckershospitalreview.com/finance/cms-releases -macra-final-rule-10-things-to-know.html. Published October 14, 2016. Accessed February 20, 2017.

2. Institute of Medicine. America’s Health in Transition: Protecting and Improving Quality. Washington, DC: National Academy Press; 1994. https://www.nap.edu/read/9147/chapter/1. Accessed February 20, 2017.

3. Gooch K. Survey: 84 percent of independent physi-cians unsure of MACRA, but 85 percent say they will participate. Becker’s Hospital Review. http://www.beckershospitalreview.com/hospital -phy-sician-relationships/survey-84-of-independent-physicians-unsure-of-macra-but-85-say-they -will-participate.html. Published January 18, 2017. Accessed February 20, 2017.

4. Quality Payment Program. Centers for Medicare & Medicaid Services. https://qpp.cms.gov. Accessed February 1, 2017.

5. Ten FAQs about MIPS. SA Ignite. http://www .saignite.com/industry-expertise/quality-payment -program/mips-education/10-faqs-about-mips/. Updated January 2017. Accessed March 6, 2017.

6. Medicare program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and criteria for physician-focused payment models. Fed Regist. 2016;81(214):77010. 42 CFR §414 and 495.

7. What are Alternative Payment Models (APMs)? Quality Payment Program. https://qpp.cms.gov /learn/apms. Accessed February 21, 2017.


What’s the Merit-Based Incentive Payment System?Those who decide to participate in the Merit-Based Incentive Payment System (MIPS) will earn a perfor-mance-based payment adjustment to their Medicare payment.19

A payment adjustment is earned via evidence-based and practice-specific quality data. Participants in MIPS show that they provided high quality, efficient care supported by technology by submit-ting information in the following categories19:

• Quality—replaces the Physician Quality Reporting System (PQRS)

• Improvement Activities—new category

• Advancing Care Information—replaces the Medicare Electronic Health Record (EHR) Incentive Program, also known as mean-ingful use

• Cost—replaces the Physician Value-Based Payment Modifier (VM)

The cost category will be calculated in 2017 but will not be used to determine payment adjustments until 2018.19

8. Centers for Medicare & Medicaid Services. 2016

Physician Quality Reporting System (PQRS):

Qualified Clinical Data Registry (QCDR) participa-

tion made simple. https://www.cms.gov

/Medicare/Quality-Initiatives-Patient-Assessment

-Instruments/PQRS/Downloads/2016PQRS

_QCDR_MadeSimple.pdf. Published October 2016.

Accessed March 9, 2017.

9. Quality Payment Program. Qualified Clinical Data

Registry (QCDR) tips: how to self-nominate and

submit data. https://qpp.cms.gov/docs/QPP

_QCDR_Self-Nomination_Fact_Sheet.pdf.


10. What we need to know about Qualified Clinical

Data Registries (QCDRs). [ReachMD audio].

American Medical Association. https://reachmd

.com/programs/inside-medicares-new-payment

-system/what-we-need-to-know-about-qualified

-clinical-data-registries-qcdrs/8501/. Accessed

February 16, 2017.

11. QCDR. American Society of Anesthesiologists.

http://www.asahq.org/quality-and-practice-man

agement/quality-reporting-nacor/qcdr. Accessed

February 10, 2017.

12. MIPS quality measures. American Society of

Anesthesiologists. http://www.asahq.org/quality

-and-practice-management/macra/asa-macra

-resources/MIPS-Quality-Component/quality

-measures. Accessed February 10, 2017.

13. Richardson E. MIPS: Clinical Practice Improvement

Activities and the QCDR. Encompass Medical

Partners. https://encompassmedical.com/mips

-cpia-qcdr/. Published August 16, 2016. Accessed

February 1, 2017.

14. The Diabetes Collaborative Registry: transforming

the future of diabetes care. Diabetes Collaborative

Registry. https://www.ncdr.com/WebNCDR

/Diabetes/publicpage. Accessed February 10, 2017.

15. Diabetes Collaborative Registry. Program measures

and metrics. https://www.ncdr.com

/WebNCDR/docs/default-source/Diabetes-Public

-Documents/diabetescollaborativeregistrymea

sures.pdf?sfvrsn=22. Updated November 16, 2015.

Accessed February 10, 2017.

16. Centers for Medicare & Medicaid Services, US

Department of Health and Human Services, Quality

Payment Program. Executive summary. https://qpp

.cms.gov/docs/QPP_Executive_Summary_of

_Final_Rule.pdf. Published October 14, 2016.

Effective January 1, 2017. Accessed February 17, 2017.

17. American Medical Association. MACRA action kit

checklist. https://www.ama-assn.org/sites/default

/files/media-browser/macra-checklist_fly.pdf.


18. Educational resources. Quality Payment Program.

https://qpp.cms.gov/resources/education. Accessed

March 6, 2017.

19. What’s the Merit-Based Incentive Payment System

(MIPS)? Quality Payment Program. https://qpp

.cms.gov/learn/qpp. Accessed March 6, 2017.

AAMA 61ST Annual Conference • October 6–9, 2017 • Cincinnati, Ohio

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