AAOS November 14, 2017
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CMS Finalizes Outpatient and ASC Rule, Removes TKA From IPO List

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Quality Payment Program and Physician Fee Schedule Finalized

House Votes to Repeal IPAB

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Quality Payment Program Updates

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Quality Payment Program Updates

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula, and the Centers for Medicare & Medicaid Services (CMS) then replaced it with the Quality Payment Program. Remember – the Quality Payment Program has two tracks you can choose: Advanced Alternative Payment Models (APMs) OR the Merit-based Incentive Payment System (MIPS). AAOS has shared the details of QPP and MIPS, which can be found on our website, here: www.aaos.org/MACRA_QualityPaymentProgram/ and here: www.aaos.org/MACRA-DeliveryReform/.

Quality Payment Program

  On November 2, 2017, CMS released a final rule with comment period for its Quality Payment Program, along with its 2018 physician fee schedule rule. The Quality Payment Program final rule did not differ significantly from the proposed rule released last June. AAOS has been working closely with CMS to address many concerns related to the Quality Payment Program, including the need for additional flexibility and simplification, as well as protection for small, solo, and rural practices. Read the entire proposed rule comment letter submitted by AAOS online here. Find the CMS fact sheet on the final rule here: https://www.cms.gov/Medicare/Quality-Payment-Program/resource-library/QPP-Year-2-Final-Rule-Fact-Sheet.pdf. For any questions or comments related to this proposed rule, please email macra@aaos.org.  

CMS has designated 2017 as a transition year for quality reporting under MIPS, allowing providers to take advantage of the “Pick Your Pace” option in MIPS. There are four options during this transition period:

  • No reporting: incurs a -4% payment adjustment
  • Submit something to avoid a penalty: a single quality measure for a single patient qualifies
  • Submit partial year: submit data for a 90-day period
  • Submit a full year: submit data for full year

Those providers who submit partial or full-year data can potentially earn a positive payment adjustment. However, to avoid incurring a penalty, submission of a single measure is required. The American Medical Association (AMA) recently shared an educational tool, entitled “One patient, one measure, no penalty: How to avoid a Medicare payment penalty with basic reporting,” which includes a short video offering simple instructions for reporting.

Additionally, CMS recently sent out letters to notify providers whether they had been slated to participate in MIPS. If you have not received a letter from CMS regarding MIPS eligibility, you may use an interactive tool on the CMS Quality Payment Program website to determine if you should participate in 2017. To determine your status, enter your national provider identifier (NPI) into the entry field on the tool which can be found on the Quality Payment Program website at https://qpp.cms.gov/. Information will then be provided on whether you should participate in MIPS this year and where to find resources.

To get the latest information from CMS, visit the Quality Payment Program website. The Quality Payment Program Service Center may be reached at 1-866-288-8292 (TTY 1-877-715- 6222), available Monday through Friday, 8:00 AM-8:00 PM ET or via email at QPP@cms.hhs.gov.