It's becoming more important than ever to measure and report health care quality. According to the National Committee for Quality Assurance (NCQA), this reporting has led to quality advancements that have saved more than 53,000 lives over the past 10 years.
Quality measures help measure or quantify health care processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care, including care that is:
Learn more about how Henry Schein can help you provide comprehensive quality care for specific conditions and specialties, including:
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) brought major changes to how Medicare clients are paid. MACRA established the Quality Payment Program (QPP), which rates and pays Medicare Part B clinicians based more on quality and cost performance, rather than the previous fee-for-service system. MACRA will shift the health care from a volume-based industry to one that is completely value-based.
The first performance year began on January 1, 2017. In 2017, more than 712,000 clinicians were expected to participate in MACRA's Quality Payment Program, which placed them in one of two value-based tracks:
MIPS was expected to be followed by 87% of these clinicians. MIPS is a net-neutral program where the financial penalties completely offset the cost of the financial incentives.
CMS estimates that up to 418,000 physicians will be submitting 2017 MIPS data.
Click here to download the full list of measures under consideration by CMS.
The 2018 final rule, released by CMS in November 2017, brought additional changes, including:
Most importantly, providers must prioritize their Quality performance improvement and Cost control efforts in 2018. Quality and Cost performance will become key determinants of high-performing providers because of three factors1:
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For 2018, CMS launched a single, user-friendly QPP website, which provides an easier way for eligible clinicians to submit data. This is an improvement from the former systems under the CMS legacy programs, which required clinicians to submit data on multiple websites.
The 2017 submission period runs from January 2 to March 31, 2018, except for groups using the CMS web interface; that submission period is January 22 to March 16, 2018.
The QPP established four categories on which clinicians will be scored:
In 2017, three categories made up the Composite Performance Score (CPS) for MIPS participants.
In 2018, all four categories will contribute to the CPS for MIPS participants.
Value-based care models rely heavily on providing high-level quality care.
The quality category focuses on how effective a clinician cares for and treats their patient population. Quality measures make them accountable for clinical health outcomes of their patient populations.
For 2017, the quality category score will be weighted at 60% of the overall MIPS composite score. Most clinicians will be expected to report up to six quality measures, including an outcome measure, for a minimum of 90 days. Groups sending MIPS data using the web interface must report 15 quality measures for a full year.
Improving quality would not be possible without clinical and operational improvement activities (IA)
In the new IA category for 2017, clinicians are rewarded for care focused on care coordination, beneficiary engagement, and patient safety. The IA category carries a weight of 15% of the overall composite score.
Improvement activities can be strengthened only by advancing care information (ACI)
The ACI category focuses on how effectively a clinician shares care information to all key stakeholders—patients, colleagues, and/or a network of fellow clinicians.
For 2017, the ACI category score will be weighted at 25% of the overall composite score. There are two category options for reporting, one of which eases transition into complete ACI objectives and measures. The option used to submit data is based on the clinician's electronic health record (EHR) edition.
Advancing communication and implementing improvements will help drive down the cost of care
Cost will come into play in 2018, with a weight of 10% of the score.
Cost deals with how economically clinicians provide care to their patients, both as individuals and as a population. We know preventive care keeps cost low, which means:
High-quality care = Reduced cost
Therefore, by 2020, the cost and quality categories will each carry a weight of 30%.
Cost will be the easiest category for clinicians to report, because no data needs to be submitted—CMS calculates performance based on submitted claims.
You should be aware of these key compliance dates:
Visit qpp.cms.gov for more information.
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