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Quality Payment Program proposed changes for 2018

  • Thursday, 03 August 2017 03:00
  • Written by 

Staying current with the CMS Quality Payment Program is essential for providers.  My previous blog—provided an overview of the program; then, on June 20, 2017, CMS announced changes that represent incremental modifications based on clinician feedback (100 stakeholders/47,000 people) as of January 1, 2017. CMS’s stated goal of reducing burden is idealistic even though the existence of these regulations continues to add administrative burden to healthcare providers. Participation is in effect not optional, but the CMS “Pick Your Pace” promotion attempts to soften the requirement.

Included in the changes are nine areas of accommodation for clinicians to encourage participation. Emphasis is placed on individual providers and small practices.  Full details of the changes are available on the CMS Quality Payment Program website and the proposed rule (CMS-5522-P) can be downloaded from the Federal Register as of June 30, 2017.

Individual providers are encouraged by CMS in two avenues by (1) creating virtual groups and (2) increasing the low-volume threshold intended to decrease participation burden by small groups and rural and Health Professional Shortage Areas (HPSA) and allowing for more inclusion in the exemption. 

Other proposed changes are in the scoring methodology which has been modified to include caring for complex patients, exclusive use of the CEHRT 2015 version, integrating MIPS performance improvement in scoring and adding facility based scoring. Small practices have three focused changes to foster participation with hardship exception for the ACI (Advancing Care Information) category, additional bonus points in the final score and forgiveness in the Quality performance category that awards small practices that do not meet data completeness requirements. 

These proposals for Year 2 continue the dialogue between CMS and clinicians, continuing the journey toward collaboration and improving patient health care outcomes. CMS may be taking a cue from history, as Winston Churchill once said “Courage is what it takes to stand up and speak; courage is also what it takes to sit down and listen.” 

Mary Zeigle, is a clinical analyst with the Clinical Terminology group at 3M Health Information Systems.

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Mary Zeigle

Mary Zeigle, RD, MS has been a member of the 3M HDD team since 2016. She has over 30 years’ experience in healthcare, starting as a Registered Dietitian, and also has clinical expertise in practice management (neurology, gynecology) and quality (continuous improvement, regulatory). Her interests are in supporting interoperability and finding customer solutions to their standard terminology needs including terminology mapping and concept development using SNOMED CT, LOINC, CPT, ICD-10-CM, ICD-10-PCS, and HCPCS. Mary obtained her Masters of Science in Exercise Physiology from the University of Utah.