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  • Medicare Incentive Payment Programs

    The Centers for Medicare and Medicaid Services (CMS) uses incentive payment programs to reward healthcare providers for the provision of high quality, low cost, efficient healthcare. Under these 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 will be the implementation of the provisions set forth under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. Under the MACRA legislation CMS is required to establish the MIPS in order to reward Medicare-participating physicians for high quality, high value care. IDSA sponsored a webinar on the MIPS proposed regulations. The MIPS regulations will be made final in late 2016, with a program start date of January 1, 2017. The recorded presentation can be viewed below and the slides are available for download (PDF). Additionally, we have prepared a Q&A from the webinar.

    The American Medical Association has prepared an Action Kit to help physicians and their staff prepare for implementation of the new Medicare quality programs as outlined in the MACRA legislation. The action kit is available here: MACRA Action Kit

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

    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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