5 Top-Level Strategic Objectives of CMS’ MACRA Quality Payment Program – Part 1

5 Top-Level Strategic Objectives of CMS’ MACRA Quality Payment Program – Part 1

Almost all clinics, hospitals, and physician practices have some understanding of MIPS – the Merit-based Incentive Pay System – and APM – Alternative Payment Methods, as set out by the Centers for Medicare & Medicaid Services (CMS).

–>Continue to Part 2.

Together, these two initiatives are CMS’ groundbreaking Quality Payment Program (QPP)– a set of guidelines that work to ensure that clinicians and hospital staff who provide great care to patients with Medicare and Medicaid receive a series of incentive-based rewards.

Think of MIPS of as a reasonably straightforward method by which data and measures selected by clinicians who are billing to Medicare can be analyzed. Participating clinicians can earn payment bonuses based on the amount of data they submit – from a small negative adjustment if no data is provided, to a moderate positive pay adjustment if data for a full year is submitted to CMS. 

Advanced APMs are more specialized Medicare tracks, usually focused on a specific clinical condition, a care episode, or a population of people. Opting into Advanced APMs can earn clinicians higher bonuses, but requires more comprehensive reporting, and the assumption of a small amount of risk.

In this and subsequent posts, we’ll take a look at the high-level objectives of MIPS and APM as set forth by the CMS, and how the Quality Payment Program works to provide better patient outcomes and better clinician experiences.

Objective 1 – Improving Beneficiary Outcomes And Engaging Patients Via Patient-Centric, Advanced MIPS and APM Policies

The first objective of the Quality Payment Program is to use APM and MIPS policies that are patient-centric to enhance the quality of care provided by clinicians.

This is done by finding new and innovative ways to reward clinicians by providing reward-based methods that can promote a more meaningful, supportive relationship between health care providers and patients. Both MIPS and APM policies rely on metrics that measure the quality of care.

The Quality Payment Program seeks to improve beneficiary outcomes by allowing clinicians to spend more time with patients and design custom treatment solutions that are appropriate for the patient.

There are three levels of intimacy to consider when properly engaging patients in healthcare decisions:

  • Incorporating the patient’s’ needs.
  • Identifying the patient’s values.
  • Utilize any preferences requested by the patient.

Incorporating the patient throughout the decision-making process will empower the patient and enable them to feel secure in their upcoming procedure.

Objective 2 – Enhancing Clinician Experiences By Using Flexible, Transparent Program Designs And Interactions

The “clinician experience” is defined as the full, end-to-end user experience where clinicians interact with CMS to communicate the Quality Payment Program initiatives and their component employees, resources, and systems. CMS has built a program that is intended to be flexible and modern, allowing physicians to be supported with accurate, timely data.

The new Quality Payment Program is developed to be unobtrusive, to reduce the burdens on administrative staff, and to improve cost and quality performance measurements. The QPP allows physicians to focus on patient care, rather than wading through paperwork or administrative duties and increases patient outcomes.

Overall, the Quality Payment Program will have these effects on clinicians:

  • A flexible program instead of one-size-fits-all
  • Meeting clinicians where they are so that they can make their own choices
  • Reducing burden on providers by using telemedicine for data gathering
  • Improving how we measure cost and quality performance.

We’ll look at three more QPM strategic objectives in our next post. In the meantime, have a look here for way Forward Health Group can help your practice make the most of MIPS.

—> Continue to Part 2.