In January 2017, Centers for Medicare and Medicaid Services (CMS) launched the Quality Payment Program (QPP), signaling the shift in reimbursement from fee-for-service to value-based care by rewarding high quality care while driving improvements in care processes, increasing use of electronic healthcare information and reducing healthcare costs.
QPP is an attempt to distribute reimbursement in a budget-neutral, value-based manner and allows clinicians to participate via one of two tracks as they begin their value-based journey: Merit-based Incentive Payment System (MIPS) or as an Advanced Alternative Payment Model (aAPM). MIPS combines and expands upon legacy programs and is intended to drive us toward aAPM. The aAPM track has potentially greater bonus opportunities while sharing in increased risk through novel healthcare delivery models.
UW Medicine, like most clinician practices, began on the MIPS track for the 2017 performance year with our score impacting covered professional service payments made under, or based on, the Medicare Physician Fee Schedule in 2019. For 2017, MIPS evaluated our performance in three areas: quality metrics (ambulatory preventive care metrics), improvement activities (enhancing care coordination and engagement of patients), and promoting interoperability (use of the electronic health record and the exchange of health information between clinicians and patients). In 2018, an additional category evaluating the cost and utilization of care will be added accounting for 10 percent of the MIPS score in 2018 and potentially more in 2019.
UW Medicine just received our 2017 scores, which were submitted as groups based on the clinicians’ billing tax identification number (TIN), and we are pleased to announce that all six groups will receive positive Medicare payment adjustments for professional services in 2019:
While this is a great step on our journey towards the triple aim of providing high quality care, improving population health, and reducing healthcare costs, we must continue our efforts in support of the Financial Improvement and Transformation (FIT) initiative, our Care Transformation, and the establishment of a Clinically Integrated Network in order to succeed in the increasing value-based care landscape.
Tim Dellit is President of UW Physicians. Robin DeForest is Contracting Program Manager with UW Medicine Contracting and Payer Relations.
