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  • Medicare Incentive Payment Programs

    The Centers for Medicare & Medicaid Services (CMS) uses incentive payment programs to reward healthcare providers for the provision of high quality, low cost, efficient healthcare. Under value-based programs, CMS sets parameters by which incentives or penalties are determined. Information on these programs can be found on this webpage.

    Medicare's Merit-Based Incentive Payment System (MIPS) for Physicians

    The newest iteration of CMS paying for high quality, value-based care is the implementation of the provisions set forth under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. Under MACRA legislation, CMS is required to establish the Quality Payment Program (QPP) in order to reward Medicare-participating physicians for high quality, high value care. The QPP is composed of two tracks, the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMS). ID physicians may choose which track to participate in based on practice size, location, or patient population. In general, most ID physicians will participate in the MIPS, at least in the early years of the program.  The QPP will begin January 1, 2017.

    In an effort to educate our members, IDSA sponsored a webinar on the QPP final regulations. The webinar provided background information as well practical information that ID physicians may need when participating in the QPP. The recorded presentation can be viewed below and the slides are available for download (PDF). 

     

    The American Medical Association (AMA) has prepared several resources to help physicians and their staff prepare for participation in the QPP for Physicians.  The AMA resources, including podcasts, learning modules, and webinars is available here: Understanding MACRA. The MACRA Assessment tool, which can be found here MACRA Assessment Tool, is an easy to understand tool that will help providers determine how they fit into the Quality Payment Program, and will help providers determine the financial implications of participation. The tool is free to use, requiring a simple registration process.  

    The American College of Physicians has also released educational materials to assist physicians with the transition to the new Quality Payment Program as mandated by MACRA. These resources are available here: ACP MACRA Resources

    CMS has prepared educational resources dedicated to the QPP. IDSA encourages members to review the CMS resources as well as the other resources mentioned. CMS QPP Resources

    A list of commonly used acronyms is also available. MIPS and MACRA Acronyms.

    IDSA has prepared a QPP participation and eligibility document for our members. This documents outlines the criteria for participation in the MIPS track of the QPP. 

    Legacy Quality Improvement Programs

    The new QPP replaces the Physician Quality Payment Program, the EHR Incentive Payment Program and the Value-Modifier program. Beginning January 1, 2017, these programs will no longer be effective. However, the last payment adjustments, based on 2016 data will be made in 2018.

    EHR Incentive Payments

    The Medicare and Medicaid EHR Incentive Programs provides incentive payments to eligible medical care providers as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology.

    For information on the use of EHRs visit the CMS EHR Program Information website. 

    CertifiedHealth IT Product List (CHPL) website provides a comprehensive listing of EHR certified technology platforms. 

    To register and attest to meaningful use, visit EHR Registration and Attestation.  

    Contact the EHR Information Center Help Desk for more information or with questions on the EHR Program (888) 734-6433; TTY: (888) 734-6563.

    PQRS Incentive Payments

     

    The Physician Quality Reporting System (PQRS) is a voluntary reporting program that provides an incentive payment to eligible individuals and practices who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries.

    PQRS Website
    Comprehensive PQRS information available through the CMS website.

    ID-Specific PQRS Resources
    Information for ID physicians on how to earn incentive payments through Medicare PQRS Incentive Payments.

    Value-Based Payments

     

    Value-based payment models are focused on encouraging high value healthcare delivery through integration, improved care coordination, and a focus on patient safety. These models are designed to foster a culture of accountability that rewards high quality, cost-effective care.

    Mandated by the Affordable Care Act, CMS applied a value modifier under the Medicare Physician Fee Schedule in 2015. Payment adjustments are calculated by cost and quality data for physicians in groups of 100 or more eligible professionals who submit claims to Medicare under a single tax identification number. By 2017, all physicians who participate in fee-for-service Medicare will be impacted by the value modifier based off PQRS quality data.

    Please visit the CMS Value-Based Payment Modifier page for more information.

    IDSA and other physician groups believe that the performance data underpinning the physician feedback reports and the Value-Based Payment Modifier must be based on clinically valid and risk-adjusted measures that attribute care to the appropriate physicians. IDSA continues to work with its members, stakeholder groups, and CMS in developing appropriate and meaningful measures for infectious diseases physicians to report.

    For information on other CMS value payments models visit IDSA Resources on Value-Based Payment models  

     

    eRx Incentive Payments

     

    The Electronic Prescribing (eRx) Incentive Program was a reporting program that provided incentive payments and payment adjustments to encourage electronic prescribing by medical care providers.

    2013 was the final year of the eRx Incentive Program. Electronic prescribing is still required for the EHR Incentive Program.

    eRx Incentive Program Website provides background information on the eRx program and directs users to the EHR CMS website.


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