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Quality Payment Program: Don’t Leave Money on the Table

April 1, 2021
April 1, 2021

The following blog post is taken from remarks by Karen Sorensen, AVP of National Initiatives at HealthStream, during a recent Webinar titled “MACRA and MIPS: Is Your Practice Leaving Money on the Table?”

A large contingent of providers are not expected to participate in MACRA’s Quality Payment Program (QPP), despite the large penalties. If you find yourself in that category, we encourage you to submit something, if only one measure, to avoid a 4% negative adjustment in Medicare payments based on this year’s performance.

Where Should You Begin?

Visit the QPP website at qpp.cms.gov for a complete list of ways to participate. The following are a few measures that fall under the patient experience umbrella:  

  • CAHPS for MIPS clinician/group survey
  • Participation in CAHPS or other supplemental questionnaire
  • Regularly assess patient experience/care through surveys, advisory councils, and/or other mechanisms
  • Collection and follow-up on patient experience and satisfaction data on engagement
  • Collection and use of patient experience and satisfaction data on access
  • Implementation of formal quality improvement methods, practice changes, or other practice improvement processes
  • Leadership engagement in regular guidance and demonstrated commitment for implementing practice improvement changes
  • Administration of the AHRQ survey of patient safety culture

The CAHPS for MIPS clinician group survey is one of the measures under the Quality category, and it's an option for groups with a sufficient number of primary care patient visits. HealthStream is a CMS-approved survey vendor, and we can implement the survey for practices eligible to conduct the survey.

The remaining items listed above fall under the Improvement Activities category. Practices could potentially earn credit on several of these measures if they are conducting CG-CAHPS, PCMH-CAHPS, HealthStream’s CG Express Survey, or another patient experience survey.  Remember, practices only need to submit one quality, one improvement, or the baseline EHR measures to avoid that negative adjustment. 

Do Something

If you take nothing else from this post, keep this in mind that you don’t need to leave money on the table. Visit the QPP website and look at your options for reporting.

In the proposed rule for 2018, CMS is planning to continue allowing clinicians to pick their pace, but next year practices will need to report on an entire category. In addition, the stakes are even higher next year, when Medicare payments will be adjusted up to 5%.

What Does the Future Hold?

About half of physicians practice in groups of five or fewer. These smaller practices may find it harder to survive the transition to value-based care with its reporting and process-improvement burdens.

Further, physicians in smaller practices tend to be older on average than doctors in larger practices. We may see some of these older physicians decide to retire, with others seeking the shelter of larger groups that are performing at a high level of quality, and are also adept at aggregating, analyzing, and reporting data. If those early physician retirements come to pass, it could worsen existing shortages in many specialties.

We can also expect to see significant adoption of technology to support MIPS reporting and quality improvement. Until now, physicians have been reluctant to make these tech investments, simply because they didn't have to. The Quality Payment Program is going to force that investment to be made.

For another great resource on the Quality Payment Program, listen to our Second Opinions Podcast with Dr. Miles Snowden. Dr. Snowden is the Chief Medical Officer of TeamHealth, a group of over 19,000 clinicians across the country. He shares several interesting observations on what the MACRA will mean to the practice of medicine.

Listen to the Webinar.