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MACRA, QPP Resources

Your resources for MACRA, MIPS, QPP and more

The Medicare Access and Children’s Health Insurance Plan Reauthorization Act (MACRA) was signed into law on April 16, 2015.  MACRA is bipartisan legislation which repealed the Sustainable Growth Rate and established the Quality Payment Program (QPP).  The QPP requires that most physicians who submit claims to the Centers for Medicare and Medicaid Services (CMS) participate in one of two programs: Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Model (APM).   There are currently no approved vascular APMs.  As such, most vascular surgeons who satisfy the QPP requirement through participation in an APM are part of a multi-specialty Accountable Care Organization (ACO).  Physicians who do not participate adequately in QPP will experience financial penalties in their Medicare reimbursements.

The requirements for adequate participation in QPP have increased each year since QPP was first implemented.  Likewise, the percentage of financial penalty has also increased each year from 4% in the first year to 9% in the fourth year and beyond.  2019 is Year 3 of the QPP.  In 2019, providers who participate in MIPS are required to report in four categories: Quality, Improvement Activities (IA), Promoting Interoperability (PI) and Cost.  In the 2019 reporting year, Quality accounts for 45% of the MIPS final score, PI for 25%, IA for 15% and Cost for 15%. The final MIPS score is used to determine how the provider’s reimbursement will be adjusted.  Scores below the minimum required score will incur a penalty.  Scores at or slightly above the minimum required score will experience no payment adjustment.    Scores significantly above the minimum will be rewarded with a positive payment adjustment.  Finally, scores above a threshold for exceptional performance are eligible for a portion of $500 million each year for the first 6 years of MACRA.

Updates

Virtual Groups Election Period for MIPS 2019 Performance Year Now Open

What is PTAC's Role in Fostering the Development of APMs?  (March 2018) A good primer on the MIPS process in Washington, DC

Quality Payment Program Year 2 / Final Rule Overview (pdf)

Information

Vascular Quality Initiative Resource Library - Search under "Quality Improvement" and "Regulatory Guidelines."

CMS Resource Library A trove of background information, documents and downloads

Featured Articles

Monthly topics published in the Journal of Vascular Surgery and JVS-Venous and Lymphatic Disorders

MACRA

QPP

APMs

MIPS

Other Articles

VQI webinars:

Washington issues that affect U.S. members

Work Progressing on Official SVS Advanced Alternative Payment Model. (Oct. 5, 2017) After nearly six months of preliminary work, the APM Task Force now is focusing on developing a vascular-specific Advanced Alternative Payment Model.

Task Force Formed to Create Alternative Payment Model. (May 12, 2017)

SVS Supports Repeal of Independent Payment Advisory Board. (June 23, 2017) The Independent Payment Advisory Board, created by the 2010 Affordable Care Act to control Medicare spending, threatens the ability of Congress to ensure access to needed health care, say SVS advocacy staff and members. Read more.

Washington Update: Interview with Dr. Sideman. (Aug. 16, 2017) Many surgeons remain unaware of MACRA’s details and ramifications. "There are going to be a lot of people who will be blindsided by this as it kicks in," Dr. Sideman warns.

SVS Supports Medical Liability Reform Bill. (July 26, 2017) Legislation is modeled after medical liability reform laws already in place in Texas and California, among other states that have a positive effect on increasing access to care and keeping health care costs affordable for patients and physicians.

CMS to Cover Supervised Exercise Therapy. (May 26, 2017) Up to 36 sessions over a 12-week period are covered if all of the components of a SET program are met.

SVS Efforts in Washington Pay Off for Members (May 12, 2017) Advocacy staff and volunteers chalk up wins.

Committee Spotlight: What's Coming? Changes to ACA but MACRA Stays (Jan. 23, 2017)

Washington Update: Highlights of the Final MACRA Rule (Dec. 6, 2016)

Priority Government Relations Issues

Washington Update: Physician Fee Schedule Includes Positive Changes

Acronym List

  • MACRA—Medicare Access & CHIP Reauthorization Act
  • PQRS—Physician Qualified Reporting System
  • QPP—Quality Payment Program (synonymous with MIPS)
  • MIPS—Merit-Based Incentive Payment Model
  • Components of MIPS 2019
    • ACI—25%--Advancing Care Information
      • For 2019, this is now PI-Promoting Interoperability
    • [CP]IA—15%--Clinical Practice Improvement Activities—CP was dropped in 2019.
    • Quality-45%--Can report through
      • Claims
      • Registry
      • HER
      • QCDR—Qualified Clinical Data Registry (e.g. VQI)
    • Cost-15%
  • APM—Alternative Payment Model
  • MIPS-CS—MIPS Composite Score
  • CEHRT—Certified Electronic Health Record Technology
  • PCMH—Patient-Centered Medical Home
  • QP—Qualifying APM participant in an Advanced APM
  • EP—Enrolled Provider
  • ONC Health IT—Office of the National Coordinator for health IT
  • DRG: Diagnosis Related Group—how hospitals are paid for a particular diagnosis
  • ACO-Accountable Care Organization
  • API-Application Programming Interface
  • ASC- Ambulatory Surgery Center
  • CAHPS-Consumer Assessment of Healthcare Provider and Systems
  • CMS-Centers for Medicare and Medicaid Services
  • HPSA-Health Professional Shortage Area
  • IVD-Ischemic Vascular Disease
  • MSPB-Medicare Spending per Beneficiary
  • MSSP- Medicare Shared Savings Program
  • NPI-National Provider Identifier
  • TIN-Taxpayer Identifier Number
  • TPCC-Total per Capita Costs