With the termination of the Sustainable Growth Rate formula through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), clinicians who participate in Medicare Part B will now be reimbursed through a new payment model called the Quality Payment Program (QPP).
How It Works
The QPP rewards the delivery of high-quality patient care via two tracks: An Advanced Alternative Payment Model (APM) or the Merit-Based Incentive Payments System (MIPS). Participants in either track will be required to report on quality measures to receive rewards and avoid penalties.
According to ACR Board Member William Harvey, MD, APMs are new and, for most rheumatologists and groups, something to consider in the future. Most rheumatologists will be in the MIPS pathway, he says, noting that the pathway is a combination of existing programs given different names, along with a new program, called Care Improvement, which was borrowed from Maintenance of Certification policies (see Table 1).
| Table 1: Programs in MIPS Pathway | |
| New Name | Former Name |
| Advancing Care Information | Meaningful Use |
| Quality | PQRS |
| Resource Use (cost) | Value-Based Modifier |
| Care Improvement | New Program |
Through the MIPS pathway, participants will be required to report up to six quality measures. During 2017, the transition year, however, participants are required to report on one measure for only 90 days to avoid penalty. Note: This measure does not include resource use, says Dr. Harvey.
“Because we prescribe expensive drugs, this maximizes the opportunity for rheumatologists to do well this first year,” he says.
Considerations for Rheumatologists
Given that only one measure needs to be reported during the 2017 transition year, Dr. Harvey suggests that rheumatologists thinking about or nearing retirement can do the minimal work necessary to participate. “If you are close to retirement, you can participate now while it’s easy, see how you do, and stick around another year or two if you are successful or until the penalties hit,” he says.
For rheumatologists in an employee group, such as a hospital, academic medical center or large multidisciplinary group, he emphasizes the need to understand how the group is participating in the QPP. Although administrators manage the program, he suggests rheumatologists could receive support from the group via some of the cost savings and efficiencies achieved through the QPP. “It’s high time that rheumatology divisions get some of the support that’s usually reserved for primary care coordination,” he says.
Future Direction
Although most rheumatologists will currently participate in MIPS, Dr. Harvey emphasizes that the goal of the CMS is to get most clinicians and groups to participate in an APM within five years, and the CMS is also working on other payment models. However, given that past payment models have not been favorable to rheumatologists, he says the ACR has taken initial steps to create a rheumatology-focused payment model, “so that in future years we will not be pigeon-holed into a complicated system or advanced system that doesn’t fit our practice style.”
