5 Things You Should Know About Value-Based Payment

5things

With the new payment system at hand, there’s a lot of information swirling around for physicians to learn. The Bulletin asked Gregory N. Nicola, new chair of the ACR MACRA Committee, what radiologists need to know about the new payment system.

1. The SGR is no more.

You’ve probably heard by now, but if you haven’t — in 2015, the Sustainable Growth Rate was repealed by Congress. In its place is the Quality Payment Program, which aims to tie physician payments to value-based metrics. Physicians can demonstrate value through two programs: the Merit-based Payment System (MIPS) and alternative payment models (APMs). Learn more about the QPP, MIPS, and APMs in “Catch Your Wave.”

 

2. MIPS has four performance categories.
If you are participating in MIPS, your payment will be determined by a composite performance score in four categories: quality, cost, advancing care information (formerly Meaningful Use), and a new category called clinical practice improvement activities (defined as activities seen as “improving clinical practice or care delivery and that the Secretary of HHS determines will likely result in improved outcomes”) .

 

3. Those that use QCDR/NRDR are at an advantage.
The National Radiology Data Qualified Registry (NRDR) and other qualified clinical data registries (QCDR) allow practices to compare their quality performance metrics to those of other practices nationwide. According to Nicola, “Groups will be in a much better position to join an APM if they’ve already gone through the registry reporting process and tried to act on the data they’ve gotten back as a result.”

 

4. The proposed start date for the QPP is January 1, 2017.
Those physician groups who meet the performance criteria in MIPS will see a payment adjustment, which can be a bonus or penalty, of up to 4 percent in 2019. That will increase every couple years until it caps at 9 percent.

 

5. There may be extra considerations for physicians who have less face to face contact with patients.

The MACRA statute allows for considerations for "non-patient" facing clinicians who may not have measures to report into all of the MIPS performance categories. However, the exact definition of non-patient facing clinician is based upon a yet to be published cpt code list. Stay tuned

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