News: CMS announces “pick your pace” for provider quality payment programs

Providers will be able to choose how they participate in the first Quality Payment Program (QPP) performance period set to begin January 1, 2017, according to a statement by CMS.

The bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ends the Sustainable Growth Rate (SGR) formula for determining Medicare payments for providers’ services, establishes new framework for rewarding providers for quality care, and combines existing quality reporting programs into one system. These provisions collectively form the QPP.

After reviewing feedback to its QPP implementation plan, released in April 2016, CMS sided with providers, who were concerned about bandwidth and balancing quality reporting and patient care.

Eligible physicians and clinicians will be able to select from four levels of participation:

1. Test the program
2. Participate for part of the calendar year
3. Participate for full calendar year
4. Participate in advanced payment models

Choosing one of these options ensures providers do not receive negative payment adjustment in 2019, the first year the agency plans to impose penalties related to the quality program, says CMS. For the first option, providers may submit some data to CMS to ensure their system is working and physicians are prepared for broader participation in future years. The second and third options allow providers to submit information for all or part of the calendar year.

Those who opt for partial year participation can choose when they submit their data and still qualify for a small payment adjustment, says CMS. Practices participating for the full calendar year can quality for a slightly larger positive payment adjustment. When submitting their data, providers can select their practice’s improvement activities and how their practice uses technology from a list of measures and activities provided by CMS.

For the fourth option, instead of reporting quality data, providers can participate in the Quality Payment Program by joining an Advanced Alternative Payment Model (APM), such as Medicare Shared Savings Track 2 or 3. If a practice receives enough Medicare payments or sees enough Medicare patients through an APM in 2017, the practice can quality for a 5% bonus incentive payment in 2019.

CMS is offering physician practices resources and support once they select their reporting plan. The agency will release the final details about the program later this fall.