scholarly journals Quality measures in the Merit-based Incentive Payment System

2018 ◽  
Vol 68 (3) ◽  
pp. 931-932 ◽  
Author(s):  
Jessica P. Simons ◽  
Karen Woo ◽  
Jill A. Rathbun ◽  
Brad L. Johnson ◽  
Timothy P. Copeland
Keyword(s):  
Quality Measures ◽  
Payment System ◽  
Incentive Payment

scholarly journals Merit-Based Incentive Payment System: Meaningful Changes in the Final Rule Brings Cautious Optimism

2017 ◽  
Vol 1 (21;1) ◽  
pp. E1-E12 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Quality Improvement ◽  
Resource Use ◽  
Quality Measures ◽  
Payment System ◽  
Sustainable Growth ◽  
Composite Score ◽  
Care Providers ◽  
Incentive Payment ◽  
Final Rule ◽  
Care Information

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) eliminated the flawed Sustainable Growth Rate (SGR) act formula – a longstanding crucial issue of concern for health care providers and Medicare beneficiaries. MACRA also included a quality improvement program entitled, “The Merit-Based Incentive Payment System, or MIPS.” The proposed rule of MIPS sought to streamline existing federal quality efforts and therefore linked 4 distinct programs into one. Three existing programs, meaningful use (MU), Physician Quality Reporting System (PQRS), valuebased payment (VBP) system were merged with the addition of Clinical Improvement Activity category. The proposed rule also changed the name of MU to Advancing Care Information, or ACI. ACI contributes to 25% of composite score of the four programs, PQRS contributes 50% of the composite score, while VBP system, which deals with resource use or cost, contributes to 10% of the composite score. The newest category, Improvement Activities or IA, contributes 15% to the composite score. The proposed rule also created what it called a design incentive that drives movement to delivery system reform principles with the inclusion of Advanced Alternative Payment Models (APMs). Following the release of the proposed rule, the medical community, as well as Congress, provided substantial input to Centers for Medicare and Medicaid Services (CMS),expressing their concern. American Society of Interventional Pain Physicians (ASIPP) focused on 3 important aspects: delay the implementation, provide a 3-month performance period, and provide ability to submit meaningful quality measures in a timely and economic manner. The final rule accepted many of the comments from various organizations, including several of those specifically emphasized by ASIPP, with acceptance of 3-month reporting period, as well as the ability to submit non-MIPS measures to improve real quality and make the system meaningful. CMS also provided a mechanism for physicians to avoid penalties for non-reporting with reporting of just a single patient. In summary, CMS has provided substantial flexibility with mechanisms to avoid penalties, reporting for 90 continuous days, increasing the low volume threshold, changing the reporting burden and data thresholds and, finally, coordination between performance categories. The final rule has made MIPS more meaningful with bonuses for exceptional performance, the ability to report for 90 days, and to report on 50% of the patients in 2017 and 60% of the patients in 2018. The final rule also reduced the quality measures to 6, including only one outcome or high priority measure with elimination of cross cutting measure requirement. In addition, the final rule reduced the burden of ACI, improved the coordination of performance, reduced improvement activities burden from 60 points to 40 points, and finally improved coordination between performance categories. Multiple concerns remain regarding the reduction in scoring for quality improvement in future years, increase in proportion of MIPS scoring for resource use utilizing flawed, claims based methodology and the continuation of the disproportionate importance of ACI, an expensive program that can be onerous for providers which in many ways has not lived up to its promise. Key words: Medicare Access and CHIP Reauthorization Act of 2015, merit-based incentive payment system, quality performance measures, resource use, improvement activities, advancing care information performance category

Emergency clinician participation and performance in the CMS Merit‐based Incentive Payment System

2021 ◽  
Author(s):  
Cameron J. Gettel ◽  
Christopher R. Han ◽  
Michael A. Granovsky ◽  
Carl T. Berdahl ◽  
Keith E. Kocher ◽  
...  
Keyword(s):  
Payment System ◽  
Incentive Payment ◽  
And Performance

Otolaryngologist Performance in the Merit-Based Incentive Payment System in 2018

2021 ◽  
pp. 019459982110328
Author(s):  
Lauren E. Miller ◽  
Neil S. Kondamuri ◽  
Roy Xiao ◽  
Vinay K. Rathi
Keyword(s):  
Pay For Performance ◽  
Payment System ◽  
Incentive Payment ◽  
Cross Sectional ◽  
Medicare Data ◽  
And Performance ◽  
Value Based Care ◽  
Sectional Analysis ◽  
Median Change ◽  
Payment Models

In 2017, the Centers for Medicare and Medicaid Services transitioned clinicians to the Merit-Based Incentive Payment System (MIPS), the largest mandatory pay-for-performance program in health care history. The first full MIPS program year was 2018, during which the Centers for Medicare and Medicaid Services raised participation requirements and performance thresholds. Using publicly available Medicare data, we conducted a retrospective cross-sectional analysis of otolaryngologist participation and performance in the MIPS in 2017 and 2018. In 2018, otolaryngologists reporting as individuals were less likely ( P < .001) to earn positive payment adjustments (n = 1076/1584, 67.9%) than those participating as groups (n = 2802/2804, 99.9%) or in alternative payment models (n = 1705/1705, 100.0%). Approximately one-third (n = 1286/4472, 28.8%) of otolaryngologists changed reporting affiliations between 2017 and 2018. Otolaryngologists who transitioned from reporting as individuals to participating in alternative payment models (n = 137, 3.1%) achieved the greatest performance score improvements (median change, +23.4 points; interquartile range, 12.0-65.5). These findings have important implications for solo and independent otolaryngology practices in the era of value-based care.

Development of a Knee Arthroplasty Episode-Based Cost Measure for Evaluating Cost in the Merit-Based Incentive Payment System

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Nirmal Choradia ◽  
Joyce Lam ◽  
Binglie Luo ◽  
Sam Bounds ◽  
Adolph J. Yates ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Payment System ◽  
Incentive Payment

How Did Orthopaedic Surgeons Perform in the 2018 Centers for Medicaid and Medicare Services Merit-based Incentive Payment System?

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Thomas B. Cwalina ◽  
Tarun K. Jella ◽  
Alexander J. Acuña ◽  
Linsen T. Samuel ◽  
Atul F. Kamath
Keyword(s):  
Payment System ◽  
Incentive Payment ◽  
Orthopaedic Surgeons

scholarly journals Otolaryngologist Performance in the Merit-Based Incentive Payment System in 2017

2020 ◽  
Vol 146 (7) ◽  
pp. 639
Author(s):  
Roy Xiao ◽  
Vinay K. Rathi ◽  
Neil Kondamuri ◽  
Shekhar K. Gadkaree ◽  
Krish Suresh ◽  
...  
Keyword(s):  
Payment System ◽  
Incentive Payment
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