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Welcome to the Quality Payment AdvisorSM

There is nothing simple about CMS' new Quality Payment Program (QPP). Nevertheless, it is how clinicians will be paid in the future and ACP wants to give internists and sub specialists the best chance possible to succeed in the new program. As payment reform shifts the paradigm from payment for volume to payment for quality and outcomes, ACP is giving its members the tools necessary to successfully maneuver through the QPP in 2017 and beyond.

CMS published its Notice of Proposed Rule Making with respect to MACRA’s Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule and Criteria for Physician-Focused Payment Models on May 9, 2016.  After extensive public comment, including from ACP, the Final Rule was published in the Federal Register on November 4, 2016, with another 60 day comment period to respond to specific questions.  The Final Rule provided increased flexibility for participation in 2017, which will affect payment adjustments in 2019.   Given the Quality Payment Program’s (QPP) complexity, 2017 will be considered a “transition year,” during which eligible participating clinicians will have four options to participate in the program.  The “Pick Your Pace” options to participate in 2017 are as follows:

  1. Full Participation:  Clinicians may participate fully in all categories of the MIPS program for the entire 2017 year (January 1 through December 31) or for 90 consecutive days to receive a payment adjustment in 2019.   Exceptional performers will be eligible for an additional positive adjustment for 6 years.

  2. Partial Participation:  Clinicians may participate for a limited consecutive period of time of at least 90 days but less than a full year, and report on more than one quality measure, attest to more than one improvement activity, or report on all five advancing care information base measures plus at least one performance measure in order to receive a small positive adjustment in 2019.

  3. Test Participation:  Clinicians may “test” their ability to report data by submitting a single Quality measure, attesting to a single Improvement Activity or submitting the five required base measures from the Advancing Care Information category in 2017 in order to avoid a negative adjustment in 2019.

  4. Alternative Payment Model (APM) Participation:  Qualifying clinicians who are in an advanced APM may be excluded from MIPS and receive rewards through participation in the advanced APM.   

Eligible clinicians who choose not to participate in the QPP in 2017 will receive a 4% negative adjustment to their 2019 Medicare reimbursement. 

How This Tool Works

The Quality Payment Advisor is an educational tool that is intuitive to the needs of clinicians participating in the Quality Payment Program. Starting with determining who is eligible for the Quality Payment Program, which reporting pathway is best to utilize, as well as quality measure/activity selection and implementation; the Quality Payment Advisor provides a systematic approach to preparing for the new Quality Payment Program. Each question offers information and resources to guide the user through the algorithm toward an understanding of which pathway is most appropriate for their practice.  The modules provide guidance and resources to select measures and activities and help implement selected measures. It should be noted that this tool cannot help with all measures or activities but to the extent possible the ACP hopes that it proves to be useful in implementing quality measures and activities most commonly applicable to internal medicine and sub-specialty practices.