Overview A high-level overview of the Quality Payment Program final policies for the performance year. Overview A guide to help clinicians get started participating in MIPS during the performance year.
Clinicians can participate in the QPP either through MIPS —earning payment adjustments based on performance for services provided to Medicare patients—or through Advanced APMs —earning payment for delivering high-quality, high-value care.
Under MIPS, clinicians are included if they are an eligible clinician type and meet the low volume threshold, which is based on allowed charges for covered professional services under the Medicare Physician Fee Schedule PFS and the number of Medicare Part B patients who are furnished covered professional services under the Medicare Physician Fee Schedule. In , the first year of the Quality Payment Program , 95 percent of MIPS eligible clinicians participated in the program, and 93 percent of those that participated earned a positive payment adjustment.
Overview A slide presentation that provides an overview of MIPS eligibility, reporting options, performance category requirements, and payment adjustments for the MIPS performance year. See Section 6. An Alternative Payment Model APM is a payment approach developed in partnership with the clinician community that provides added incentives to clinicians to provide high quality and cost-efficient care. APMs require clinicians to view and understand data from multiple healthcare settings.
Community leaders and clinicians who wish to develop a financial model that combines healthcare and social services can download the PCCI Shared Savings Playbook [PDF — 1 MB] , a step-by-step guide for communities that are working to develop a successful shared savings program.
As we discussed in Section 6. Promoting Interoperability was formerly called Advancing Care Information and requires participants to report on measures related to use of certified electronic health record CEHRT technology. This will count for up to 25 percent of their MIPS final score. Note: Beginning with the payment adjustment year, clinicians will no longer receive a payment adjustment based on participation in the EHR Incentive Program. Instead, they may participate in MIPS and receive a positive or negative payment adjustment based on their final score, which includes performance in the Promoting Interoperability category.
Small practices defined as 15 or fewer clinicians , especially those in rural or Health Professional Shortage Areas HPSAs , play a vital role in caring for Medicare patients with diverse needs. The following website details the flexibility and support available to small and rural practices, or HPSAs, as described in the legislation.
CMS is committed to a continued dialogue regarding the obstacles and challenges these practices encounter. Support for Small, Underserved and Rural Practices. The Primary Care First PCF payment model options will test whether financial risk and performance-based payments that reward primary care practitioners and other clinicians for easily understood, actionable outcomes will reduce total Medicare expenditures, preserve or enhance quality of care, and improve patient health outcomes.
PCF will provide payment to practices through a simplified total monthly payment that allows clinicians to focus on caring for patients rather than their revenue cycle. PCF also includes a payment model option that provides higher payments to practices that specialize in care for high need patients, including those with complex, chronic needs and seriously ill populations SIP. Both models under PCF incentivize providers to reduce hospital utilization and total cost of care by potentially significantly rewarding them through performance-based payment adjustments based on their performance.
PCF will be tested for five years and is scheduled to begin in January A second application round is also planned for participants starting in January Like the PCF payment model options, the Direct Contracting DC payment model options are also focused on transforming primary care, allowing healthcare providers to take greater control of managing the costs of care for an aligned population of Medicare fee-for-service FFS beneficiaries.
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Sideline Box. Sideline Backdoor. Overview Explains basic change-management principles and discusses the importance of managing change effectively during EHR implementation. Overview Provides guidelines on what paper-record information you need to import into an EHR system. Overview Helps you create a leadership team and describes important roles and responsibilities; includes a template to use during your process.
Overview Helps you establish realistic, measurable goals for your EHR implementation. A thorough evaluation provides a solid foundation, and it will help you continue to improve the value of your EHR system. The usability of your EHR depends not only on how it is designed but also on how it's implemented. Once you have your EHR up and running, it's helpful to:.
The tools and resources in this section will help improve and optimize EHR usability and practice workflow, and drive clinical transformation. Implementing EHRs can seem like a daunting task — and teamwork is key to success. Leadership, systems, and individuals can all help improve workflows. Complete this module to learn the 8 steps for optimizing the use of EHRs in your practice. Overview A toolkit with strategies, resources and case studies to help mitigate EHR usability issues while optimizing the use of health IT.
Overview Lets you test the quality and clarity of information in clinical documents you receive during transition of care to improve care coordination. Describes an industry standard that EHRs use to exchange information among clinicians and patients. The resources in this section will help improve and optimize EHR usability, workflow, and drive clinical transformation. Overview Shows how you can use health IT to drive clinical transformation in your practice.
Overview Helps you plan, design, implement, and use health IT in ambulatory care. Overview Provides guidelines for workflow process mapping to help you optimize EHR efficiency. Migrating from paper-based documentation to an electronic health record EHR system requires careful planning, and so does migrating from one electronic environment to another. Reasons you may want to replace your EHR include:.
Careful data-migration planning ensures that your new EHR can both integrate and access historical data. Overview Provides specific guidance for transitioning to a new EHR vendor, including:. Have a tool or resource to make this Playbook even better? Share your feedback with us. Sign up for email updates about the Health IT Playbook. Explore helpful COVID resources for health IT professionals and health care providers Learn how providers and patients can use telehealth during the pandemic.
Facebook LinkedIn Twitter Print. Section 1 Electronic Health Records. In this section. Disclaimer This document should not be construed as legal advice and does not address all possible legal and other issues that may arise with the acquisition of an EHR. Electronic Health Records Contract Guide. Gather as many of these success factors as possible: Readiness Eager personnel Someone to champion the cause Stakeholders who perceive EHRs as useful Teamwork Remember: Your planning must address both the initial and the ongoing effects that EHR implementation will have on your clinical practice.
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