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URAC Applauds CMS Changes to Quality Payment Program Reporting in 2017

Wednesday, September 14th, 2016

CMS Acting Administrator Andy Slavitt announced a change in the performance data requirements for the Quality Payment Program (QPP) established by the Medicare and CHIP Reauthorization Act of 2015 (MACRA). In a September 8 blog post, Slavitt explained that CMS will now give physicians and clinicians more flexibility to “pick their pace of participation” in 2017 QPP reporting.

Physicians and clinicians will be given four options for reporting in 2017:

  1. Test the Quality Payment Program: As long as a physician submits some data, including data from after Jan. 1, 2017, they will avoid a negative adjustment.
  2. Participate for part of the calendar year: A physician may choose to submit information for a reduced number of days. This would allow for reporting after Jan. 1, 2017. Under this option, a physician practice could still qualify for a small positive payment adjustment.
  3. Participate for the full calendar year: Physicians who are ready may choose to submit information for the full calendar year that begins on Jan. 1, 2017. They will be eligible for a positive payment adjustment.
  4. Participate in an Advanced Alternative Payment Model (APM): Instead of reporting quality data and other information, a physician could choose to participate in a CMS-identified APM and receive a lump sum bonus payment.

“URAC welcomes the recent announcement by CMS of a phased approach to implementation of the Quality Payment Program for 2017,” said URAC President and CEO Kylanne Green. “As we indicated in our response to the proposed rule, flexibility and sustainability must be a hallmark of the Quality Payment Program for long term success to be recognized. CMS’ announcement of a phased approach to reporting in 2017 is recognition of this and serves as acknowledgment by CMS that practices are beginning the transition to value-based reimbursement from different starting points. We hope the flexibility with an eye toward sustainability, which CMS displayed with this announcement, is further reflected in the final rule.”

The final MACRA rule is expected to be released by November 1, 2016.

As studies have shown and CMS has recognized, time is a critical factor in the transformation process. Physicians, providers, and practices need time to learn and turn knowledge into action. This achievement over time is what makes transformation sustainable. For this reason, URAC chose not to imitate the limited certification processes that utilize a one-time survey – but instead designed a Patient Centered Medical Home (PCMH) Certification program that validates the gradual transformation of a practice.

URAC’s Green added: “We are confident that those practices that achieve URAC PCMH certification are not only well-positioned to realize a bonus under the Quality Payment Program, but they are also capable of delivering quality care to all patients in a manner that is sustainable into the future.”

Informed in part by the work of the Accreditation Work Group of the Patient-Centered Primary Care Collaborative (PCPCC), URAC’s PCMH certification incorporates the following elements to support practice change:

  • Since practices begin at different starting points, the certification and improvement process should as well.
  • URAC’s PCMH certification allows a practice to begin the process at one of three levels related to readiness.A sequential process that supports a natural order of activities leads to improvement. The first level begins with the basics of access, care coordination, and putting the patient first.
  • The process utilizes best practices and change concepts that identify the simplest and most straightforward activities for achieving outcomes.
  • It encourages putting knowledge into practice by following a process and achieving milestones where achievement over time is a natural path to transformation.
  • Practices move from concept to sustainability by focusing on what must change in order to achieve a desired outcome which enhances the likelihood of success.

Under the proposed CMS rule implementing the Quality Payment Program, physicians that are part of a practice that has achieved URAC PCMH certification are eligible for full credit under the Clinical Practice Improvement Activities in the Merit-Based Incentive Payment System (MIPS).

Please contact URAC at info@urac.org or call (202) 216-9010 with specific questions. To learn more about URAC and its accreditation programs, go to urac.org.

About URAC

Founded in 1990, URAC is the independent leader in promoting health care quality through accreditation, certification, and measurement. URAC is a nonprofit organization developing evidence-based measures and standards through inclusive engagement with a range of stakeholders committed to improving the quality of health care. Our portfolio of accreditation and certification programs span the health care industry, addressing health care management, health care operations, health plans, pharmacies, telehealth providers, physician practices, and more. URAC accreditation is a symbol of excellence for organizations to show¬case their validated commitment to quality and accountability.

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