2016-10-19 14:47:23 UTC

Oct. 19, 2016

While 2017 is a transition year for MACRA, GIs need to report quality measures to succeed.

CMS published the Medicare Access and CHIP Reauthorization Act (MACRA) final rule with some significant and important changes from what was first proposed for the Quality Payment Program (QPP). The QPP was created to replace the Physician Quality Reporting System, EHR Meaningful Use and the Value-based Payment Modifier programs that currently determine Medicare physician reimbursement.   

What is the Gastroenterology Measure Set? (see below)
CMS designed specialty-specific measure sets to address past feedback that the quality measure selection process was confusing, given that providers were asked to review approximately 300 measures and find ones applicable for their specialty.

For full participation in the quality performance category, clinicians now have the option to either report on:

  • Six quality measures that the clinician selects among the list of available measures, including one outcomes measure; or
  • Six measures in one specialty-specific measure set, including one outcomes measure, for a minimum of a continuous 90-day period.

If no outcomes measure is available in the measure set, then the clinician must report on one high-priority measure in one of the following national quality strategy domains: appropriate use, patient safety, efficiency, patient experience or care coordination. CMS previously proposed the requirement that clinicians report at least one cross-cutting measure; however, during calendar year 2017, that requirement has been suspended for further consideration in calendar year 2018 and beyond.

Use 2017 to Learn How to Participate

CMS is considering 2017 a “Transition Year and Iterative Learning and Development Period” for the QPP and, thereby, has reduced the reporting requirements during 2017 from what was initially proposed. CMS has provided four options for reporting in 2017 to allow clinicians to pick their own pace.

  1. Report to the Merit-based Incentive Payment System (MIPS) for a full 90-day period, ideally the full year, and maximize the eligible clinician’s chances to qualify for a positive adjustment.
  2. Report to MIPS for a period of less than the full year performance period 2017, but for a full 90-day period at a minimum, and report more than one quality measure, more than one improvement activity or more than the required measures in the advancing care information performance category in order to avoid a negative MIPS payment adjustment and to possibly receive a positive MIPS payment adjustment.
  3. Report one measure in the quality performance category, one activity in the improvement activities performance category or report the required measures of the advancing care information performance category and avoid a negative MIPS payment adjustment. (Clinicians who chose not to report at least one measure or activity will receive the full negative 4 percent adjustment.)
  4. Participate in Advance Alternative Payment Models (APMs) and, if they receive a sufficient portion of their Medicare payments or see a sufficient portion of their Medicare patients through the Advance APM, they will qualify for a 5 percent bonus incentive payment in 2019.

For calendar year 2017, clinicians will meet the performance threshold for the 2017 transition year if they:

  • Submit one out of at least six quality measures (more measures are required for groups that submit using the CMS web Interface).
  • Attest to at least one improvement activity.
  • Report on the required measures in advancing care information.

AGA is reviewing the MACRA regulation and will release a summary of key provisions impacting gastroenterologists in the coming weeks. Watch your email for updates on this important issue.

2017 Gastroenterology Measure Set
The MACRA final rule includes 16 gastroenterology measures.

Measure # Measure Title
047 Care Plan
128 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
130 Documentation of Current Medications in the Medical Record
185 Colonoscopy Interval for Patients with a History of Adenomatous Polyps – Avoidance of Inappropriate Use
226 Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention
271 Inflammatory Bowel Disease (IBD): Preventive Care: Corticosteroid Related Iatrogenic Injury – Bone Loss Assessment
275 Inflammatory Bowel Disease (IBD): Assessment of Hepatitis B Virus (HBV) Status Before Initiating Anti-TNF (Tumor Necrosis Factor) Therapy
317 Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented
320 Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients
343 Screening Colonoscopy Adenoma Detection Rate Measure
374 Closing the Referral Loop: Receipt of Specialist Report
390 Hepatitis C: Discussion and Shared Decision Making Surrounding Treatment Options
401 Hepatitis C: Screening for Hepatocellular Carcinoma (HCC) in Patients with Cirrhosis
402 Tobacco Use and Help with Quitting Among Adolescents
431 Preventive Care and Screening: Unhealthy Alcohol Use: Screening and Brief Counseling
439 Age Appropriate Screening Colonoscopy

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