Advancing Care Information
ACI is one of the four reporting categories of MIPS which determines 25% of the total MIPS score. This category replaces Meaningful Use and requires clinicians to report key measures of interoperability and information exchange to CMS.
Accountable Care Organization
Groups of doctors, hospitals, and other health care providers who come together voluntarily to give coordinated high quality care to their patients. Medicare has designated the following two ACOs as Advanced Alternative Payment models: Next Generation ACO and Medicare Shared Savings Program (tracks 2 and 3).
Payment vehicles that replace traditional fee-for-service payments. They reward value and quality of care, but also require physicians to bear some financial risk.
Advanced Alternative Payment Models
These are special APMs endorsed by CMS. Under MACRA, if a physician participates in an advanced APM, they will be exempt from MIPS and will receive a lump sum payment from Medicare equal to 5% of last year’s fee for service payments. There is currently not much opportunity for allergists to participate in an Advanced APM unless your practice is part of a large ACO which participates in the Medicare Shared Savings Program (tracks 2 and 3) or the Next Generation ACO.
Composite Performance Score
A single MIPS composite performance score will factor in performance in four weighted performance categories (Quality, Cost, Improvement Activities, and Advancing Care Information) on a 0-100-point scale. Eligible Clinicians above a performance threshold will receive positive payment adjustments, and those below the threshold will potentially receive negative payment adjustments.
Cost is one of the four categories of MIPS. It will not be scored in 2017. This category replaces Value Based Modifier. CMS will calculate this category based on claims for attributed patients; clinicians do not need to report anything.
Clinicians who are subject to MIPS requirements (includes physicians, physician assistants and nurse practitioners). Three groups of clinicians are NOT subject to MIPS:
IA is one of the four reporting categories of MIPS which determines 15% of the total MIPS score. IA is an activity identified as “improving clinical practice or care delivery and that the Secretary of HHS determines will likely result in improved outcomes.” There are 90 possible qualifying activities that fall under six broad categories: Expanded practice access, Population management, Care coordination, Beneficiary engagement, Patient safety and practice assessment, and Alternative payment models.
Medicare Access and CHIP Reauthorization Act
A law signed in April of 2015 that repeals the Sustainable Growth Rate formula; replaces the Physician Quality Reporting System, Meaningful Use and Value-Based Modifier with a new program called the Merit-Based Incentive Payment System (MIPS); creates incentives for physicians to participate in Alternative Payment Models (APMs) and encourages the development of physician-focused payment models.
Merit-Based Incentive Payment System
MIPS is a new program that combines parts of the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier (VBM), and the Meaningful Use EHR incentive program (MU) into one single program in which Eligible Clinicians will be measured on:
Using certified electronic health record (EHR) technology to:
Meaningful use sets specific objectives that eligible professionals must achieve to qualify for CMS Incentive Programs or to avoid penalties. The last performance year for MU is 2016; in 2017 it is replaced with MIPS. Failure to meet 2016 MU requirements will result in a Medicare payment reduction of 3% in 2018.
Patient-Centered Asthma Care Payment
An ACAAI physician-focused alternative payment model that is designed to improve outcomes for patients with asthma-like symptoms and to control costs for payers in a way that’s financially feasible for physicians.
An APM that addresses specific health problems physicians can control. PFPMs can remove barriers to improving care, which enables physicians to improve outcomes for patients and achieve savings for payers.
Physician Focused Payment Model Technical Advisory Committee
MACRA created PTAC to make recommendations to The Department of Health and Human Services (HHS) on proposals for PFPMs submitted by individuals and stakeholders. The PTAC will evaluate the extent to which proposed models meet the Secretary’s criteria and make recommendations with respect to refinement, further study, testing, and / or implementation of the proposed PFPMs.
A quality reporting program that encourages individual eligible professionals and group practices to report information on the quality of care to Medicare. The last performance year for PQRS is 2016; in 2017 it is replaced with MIPS. Failure to meet 2016 PQRS requirements will result in negative Medicare adjustments for both PQRS and VBM in 2018. Small practices will see combined Medicare penalties of up to four percent, while those with 10+ eligible providers will see combined penalties of up to six percent.
Quality is one of the four reporting categories of MIPS which determines 60% of the total MIPS score in 2017. This category replaces PQRS and requires clinicians to report quality measures to CMS.
Quality Payment Program
The name of the unified framework to implement MACRA provisions. The Quality Payment Program provides two payment paths for providers: MIPS and APMs.
Sustainable Growth Rate Formula
A method previously used by CMS to control Medicare spending. This method was meant to ensure the yearly increase in the expense per Medicare beneficiary did not exceed the growth in GDP. However, Congress regularly adjusted the SGR annually, which ultimately led to a permanent repeal as part of the MACRA legislation.
A program that measures the quality (based on PQRS) and cost of care provided to patients with Medicare that are attributed to physicians. VBM is directly tied to PQRS performance; participation in PQRS is required to avoid a VBM penalty, but no additional reporting is necessary to participate in VBM. The last performance year for Value-based modifier is 2016; in 2017 it is replaced with MIPS. Failure to meet 2016 PQRS requirements will result in negative Medicare adjustments for both PQRS and VBM in 2018. Small practices will see combined Medicare penalties of up to four percent, while those with 10+ eligible providers will see combined penalties of up to six percent.