QPP AND MIPS FOR THE

UROGYNECOLOGIST

Blair Washington MD, MHAVirginia Mason Medical Center

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MIPS for the Urogynecologist

Introduction to the Quality Payment Program (QPP)

Review the basics of the Merit-based Incentive Payment System (MIPS)

Discuss Go at your own Pace

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What is MACRA and the QPP? The Medicare Access and CHIP Reauthorization Act (MACRA) replaced

the Medicare reimbursement schedule with a pay-for-performance program focused on quality, value, and accountability

MACRA’s Quality Payment Program (QPP) changed the way Medicare pays providers and offers financial incentives for providing high-quality care (and bearing financial risk)

Beginning in 2019, QPP will assign eligible providers to either an Alternative Payment Model (APM) or a Merit-based Incentive Payment System (MIPS)

MIPS streamlines and combines existing quality incentive programs:1. The Physician Quality Reporting System (PQRS)2. The Value-based Payment Modifier (VBM), and 3. The Medicare Electronic Health Record (HER/Meaningful Use) incentive program

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The Quality Payment Program (QPP)

Providers choose how they want to participate based on: − Practice size− Specialty− Location− Patient population

Two tracks to choose from:

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Track one: Merit-Based Incentive Payment System (MIPS) Combines existing quality incentive programs into one

budget-neutral program with a single payment

Ties Medicare payments to performance- based payment adjustments

Performance thresholds determine the bonus or penalty◦ 2019: +/- 4% (based on 2017 performance)◦ 2020: +/- 5%◦ 2021: +/- 7% ◦ 2022: +/- 9%

MIPS outlines four performance categories to determine payment adjustments

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Who is ELIGIBLE for MIPS? Eligible providers◦ Physicians (MD/DO and DMD/DDS)◦ Physician Assistants ◦ Nurse Practitioners ◦ Clinical Nurse Specialists ◦ Certified Registered Nurse Anesthetists◦ Groups that includes such clinicians

Medicare part B providers ◦ Who have billed >$30,000/year ◦ Provide care to >100 Medicare patients/year

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Who is EXCLUDED from MIPS? Providers in their first year of Medicare Part

B participation

Participants in an Advanced APM

Those with a low volume of Medicare patients◦ Charges ≤ $30,000/year◦ See ≤ 100 Medicare Part B patients/year

CMS informs you that you are excluded

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MIPS – 4 Domains to Evaluate Performance

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When does QPP START? YOU CAN PICK YOUR PACE (Jill if folks haven’t

started, what are their options—accept 4% penalty?)

Choose to start anytime BETWEEN Jan 1st – Oct 2, 2017

Need to send performance data by March 31, 2018

The first payment adjustment based on performance occurs on January 1, 2019

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MIPS PICK YOUR PACE

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How much can MIPS adjust payments?

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The Quality Payment Program (QPP)

Providers choose how they want to participate based on: − Practice size− Specialty− Location− Patient population

Two tracks to choose from:

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Track two: Advanced Alternative Payment Models (APMs) For providers and organizations that go the

furthest in delivering high-quality, coordinated, and efficient care

Successful participation could earn a 5% bonus between 2019 and 2024

Higher fee schedule updates (0.75%) compared to MIPs starting in 2026+

Excluded from MIPS

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QPP and MIPS for the Urogynecologist

Introduction to the Quality Payment Program (QPP)

Review the basics of the Merit-based Incentive Payment System (MIPS)

Discuss Go at your own Pace

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