CMS Proposes Quality Payment Program Updates

CMS Proposes Quality Payment Program Updates

On Tuesday, June 20th, the Centers for Medicare and Medicaid Services (CMS) released the CY 2018 Updates to the Quality Payment Program (QPP)  proposed rule.  The proposed rule includes updates to the QPP for both the Merit-based Incentives Payment System (MIPS) and Advanced Alternative Payment Model (APM) tracks. CMS has stated that it is their goal to simplify the program, reduce burdens and offer/extend flexibilities for clinicians. CMS discusses specifically reducing burdens for small, independent, and rural practices.

It is important to note that audiologists are not eligible for participation in the QPP in the first two years (2017, 2018). The Secretary of the US Department of Health and Human Services (HHS) has the authority to include other professionals, including audiologists, beginning in 2019. This means that audiologists will not be required to report on anything in 2018, but will have the option to voluntarily report on measures through MIPS. The Academy has developed a fact sheet to assist audiologists with voluntary reporting under MIPS. The Academy is closely monitoring changes to the QPP to ensure audiologists are prepared for future participation.

Below are some highlights from proposed rule that may be of interest to audiologists who are currently engaged in voluntary reporting under MIPS or have an interest in learning more about the QPP:

  • MIPS Quality Category: CMS is not proposing any changes to the number of measures reported – clinicians will still report at least 6 quality measures, with at least one outcome measure included for the performance year 2018, the payment year 2020.   
  • MIPS Clinical Practice Improvement Activities Category: Under the MIPS program, CMS is proposing no change to the Improvement Activities category weighting, no change to the number of Improvement Activities that MIPS eligible clinicians must report, and no change to the scoring policy for APMs and MIPS APMs.
  • MIPS Payment Adjustment (Note: Audiologists will not be subject to any payment adjustment for the 2018 performance year/2020 payment year): For the 2020 payment year, the payment adjustment range is - 5% to + 5% based on 2018 performance.
  • MIPS Performance Period:  CMS will require 12-month calendar year quality and cost performance period for the 2018 performance year/2020 payment year
  • Increase Low-Volume Threshold: CMS proposes to increase the low-volume threshold (from <$30,000 to <$90,000 in Part B allowed charges OR from <100 to <200 Part B beneficiaries) so that more small practices and eligible clinicians in rural and Health Professional Shortage Areas (HPSAs) are exempt from MIPS participation.
  • MIPS Composite Score Categories:  CMS will continue the 2017 performance year weighting for the MIPS composite score categories:
    • Quality: 60%
    • Advancing Care Information: 25%
    • Clinical Practice Improvement Activities: 15%
    • Cost: 0% - however, CMS seeks comment on whether the weighting should be 10% for the 2018 performance year in line with statute

Here are some additional resources on the QPP Year 2 Proposed Rule:

CMS Fact Sheet on Proposed Rule

CMS Quality Payment Program Site

Also of Interest