Highlights of Medicare’s New Quality Payment Program

Highlights of Medicare’s New Quality Payment Program

Dr. Stephen S. Grubbs
Dr. Michael P. Kosty
Dr. Ray D. Page, credit DELO DIGITAL
In May 2015, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The purpose of the legislation is to begin the process of reimbursing physicians based on the value of their care, not the volume. During the Education Session “Business of Practice 2017: New Rules, New Strategies,” to be held on June 2,* three presenters will dig deep into the application of the law, updating attendees on practice care delivery strategies and the reporting guidelines that they will need to understand in order to be compliant starting in 2017.

“The new payment system, the Quality Payment Program, requires physicians to report quality measures that prove that they are providing better care at a lower cost,” Session Chair Stephen S. Grubbs, MD, FASCO, vice president of the ASCO Clinical Affairs Department, said. “This new approach is a challenge for physicians. The session will aim to give them some ideas about how to transform their practice and be successful.”

Physicians will be reimbursed through the Quality Payment Program by either the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models. According to Dr. Grubbs, most oncologists will practice in the MIPS system, which has a challenging reporting mechanism. His portion of the presentation will explain how to report quality measures in MIPS.

“Physicians are required to report on six quality measures annually,” Dr. Grubbs said. “Using data from their electronic health records, physicians report on their outcomes. Their performance is then compared to other physicians. If the physicians do well, they are rewarded. If they don’t, they are penalized.”

In 2017, physicians are expected to get their reporting systems up to speed. In 2018, they will start reporting their outcomes from the previous year, which will affect the payments they receive in 2019. Because of the complexity of MIPS, practice administrators will have an increasingly essential role in the operation of the practice. “For this reason,” Dr. Grubbs said, “we’re hoping to attract practice administrators to the session.”

In addition to grappling with the nitty-gritty of the law, the session will address different models of care that have the potential to increase value and lower costs. Presenter Ray D. Page, DO, PhD, FACOI, of the Center for Cancer and Blood Disorders, will explain how the patient-centered medical home, a team-based health care delivery model led by a medical provider, can help physicians improve the quality of their care in a cost-effective way. Dr. Page’s presentation will cover how this concept can be applied to the field of oncology, who makes up the medical home, and why this concept is important.

In a similar vein, the session’s third presenter, Michael P. Kosty, MD, FACP, of the Scripps Research Institute, will focus on ways that team-based care can help make medical practices more efficient. This portion of the session will emphasize how to take better care of patients at a lower cost.

“These new payment models emphasizing value represent a paradigm shift in the delivery and business side of oncology,” Dr. Grubbs said. “Therefore, it is important that both physicians and practice administrators understand how to put them in place. This session is designed to help them learn how to be successful in this new world.”   

–Marilyn Fenichel

*Program information updated as of March 14. For session time and location information, please refer to the ASCO iPlanner on the Attendee Resource Center.