decisionhealth Newsletters, Part B News - 2018 Issue 7 (July)
QPP in the PFS 2019: More patient, outcome focus; ‘gold’ quality measures; other changes
Subscribe or sign in to view the full article.
Article Overview
This article reviews proposed 2019 changes to the Medicare Quality Payment Program and the MIPS framework. It focuses on shifts in quality measurement toward patient-reported and outcome-oriented measures, revisions to Promoting Interoperability, updates for small practices and low-volume exemptions, changes affecting QCDRs, and a Medicare Advantage demonstration tied to advanced APM participation. It is useful for clinicians, practice leaders, and coding or compliance staff tracking Medicare payment policy and reporting requirements.
Why This Topic Matters
The proposed rule could change how clinicians are scored, which measures count, how interoperability is reported, and which providers are included in or exempt from MIPS. Understanding these proposals helps practices assess reporting strategy, operational impact, and potential payment consequences.
Article Sections
-
Quality Payment Program
An overview of CMS’s proposed direction for quality measurement within the Quality Payment Program and MIPS, including the general shift in measure emphasis and category changes.
-
Quality categories tiered by value
Discussion of CMS’s proposed measure-value classification approach and how quality measures would be grouped into tiers within the scoring framework.
-
More cost, less quality in MIPS score
Summary of proposed MIPS weighting changes, scoring thresholds, and the expansion of cost measurement concepts in the program.
-
Promoting Interoperability changes
Coverage of proposed revisions to the interoperability category, including the streamlined measure set and related performance expectations.
-
Welcome, new MIPS eligible
Explanation of proposed additions to the list of MIPS-eligible provider types and how new participants would be treated in scoring.
-
QPP changes for small practices
Overview of proposed adjustments intended for smaller practices, including reporting options, category treatment, and special scoring considerations.
-
New low-volume metric, opt-in option
Description of proposed low-volume exemption updates and the option for some otherwise excluded providers to elect participation.
-
CMS leans on QCDRs
Discussion of proposed changes affecting qualified clinical data registries, including standards for participation, measure submission, and sharing.
-
MA demo may boost your pay
Summary of a proposed Medicare Advantage demonstration related to advanced APM-like participation and potential effects on MIPS adjustments.
-
More changes to come?
Closing comments on the proposal timeline and the possibility of further changes before final rulemaking.
What You Will Learn
- How proposed QPP and MIPS updates would change quality measurement priorities
- What the article says about interoperability and reporting category revisions
- Which practice-size and low-volume policy changes are being proposed
- How CMS is approaching QCDRs and Medicare Advantage-related demonstrations
- What types of clinicians and practice settings may be affected by the proposals
Who Should Read This
- Physicians and other eligible clinicians
- Practice administrators
- Medical coders and billing staff
- Compliance and reimbursement professionals
- Health IT and EHR stakeholders
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com