Define Action Plan

Preparing a practice for MACRA will help physicians avoid negative payment penalties and maximize incentive payments.

Female Physician

Since MIPS is designed to be a budget-neutral program, which means that the payment adjustments are determined on a curve, requiring providers to be measured against each other to determine who qualifies for a payment increase or decrease, physicians will want to ensure they are positioning themselves to avoid negative payment adjustments and maximize incentive payments.

Basic MIPS

Depending on the track of the Quality Payment Program you choose and the data you submit by March 31, your Medicare payments will be adjusted up, down, or not at all.

2019 Payment Period.

Recognizing that physicians may face challenges in understanding the requirements and participating in the Quality Payment Program, CMS allowed physicians to pick their pace of participation for the 2017 performance period (2017 MIPS transition year) during the initial development and transition to MIPS. By choosing one of following three reporting options under MIPS, physicians may receive a positive payment adjustment and avoid a negative payment adjustment in 2019.

  1. Test – Submit data for one quality measure, OR one improvement activity, OR the four required ACI measures and avoid a negative payment adjustment.
     
  2. Partial Participation – Submit at least 90 days of data for more than one quality measure, OR more than one improvement activity, OR more than the four required ACI measures and avoid a negative payment adjustment. Partial participation also allows ECs to possibly receive a small positive payment adjustment.
     
  3. Full Participation – Submit at least 90 days of data for all required quality measures, AND all required improvement activities, AND all four required ACI measures to avoid a negative payment adjustment. Full participation also allows ECs to possibly receive a moderate positive payment adjustment.
     
  4. Advanced Alternative Payment Model – Eligible clinicians will receive a 5% bonus if they receive 25% of Medicare Part B payments, OR see 20% of patients through the AAPM.

Automatic Extreme and Uncontrollable Hardship Exemption

For the 2017 performance year, CMS will also grant an automatic hardship exemption for physicians affected by extreme and uncontrollable circumstances such as hurricanes, natural disasters, or public health emergencies. CMS will identify physicians affected by the California wildfires based on information in the Provider Enrollment, Chain and Ownership System (PECOS). CMS has identified the following California counties designated as a major disaster county by the Federal Emergency Management Agency: Butte, Lake, Mendocino, Napa, Nevada, Orange, Santa Barbara, Solano, Sonoma, Ventura, and Yuba counties. Clinicians in these counties will be granted the hardship exception without having to submit a request.  Thus, clinicians in affected areas who do not submit any data will not be subject to a negative payment adjustment in the 2019 payment year. Clinicians who do submit data will be scored on their submitted data and be rewarded for their performance. For more information, see The Extreme and Uncontrollable Circumstances Policy for the Merit-based Incentive Payment System (MIPS) in 2017 available on the CMS website at www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Interim-Final-Rule-with-Comment-fact-sheet.pdf.

2018 Performance Period

For the 2018 performance period, physicians may receive a positive payment adjustment and avoid a negative payment adjustment in 2020 by picking one of the following options:

  • Basic MIPS. Submit MIPS data for at least 90 days during the 2018 reporting period for Improvement Activities and Advance Care Information performance categories along with a full year of Quality data. Report enough data to earn at least 15 points by submitting measures under the Quality and Improvement Activity performance categories or required measures in the Advancing Care Information performance category during 2018 and avoid the negative 5 percent payment penalty. Clinician who submit enough data to earn additional points and receive a possible positive payment adjustment.
     
  • Maximizing MIPS. Meet all reporting requirements for the full year during the 2018 reporting period. Opportunity for the maximum positive payment adjustment of 5 percent in 2020. Exceptional performances are eligible for additional bonus adjustment of up to 10 percent.

See How to Avoid a Penalty in 2018 MIPS Program, available on the AMA website at www.ama-assn.org/sites/default/files/media-browser/public/physicians/macra/mips-scoring-sheet-avoid-penalty.pdf.

Maximize MIPS

The ability to maximize MIPS will provide clinicians the ability to maximize payment adjustments and receive an additional positive payment adjustment for exceptional performance under MIPS. Physicians participating in MIPS will be eligible for positive or negative Medicare payment adjustments that start at 4% and gradually increase to 9% in 2022. Distribution of payment adjustments will be made on a sliding scale and will be budget neutral

To maximize a clinicians MIPS score there are several opportunities identified to help achieve high performance scores.

Choose Full Data Submission Option

To maximize the opportunity of a 2019 higher positive adjustment MIPS clinicians will have had to choose either to submit full data submission or partial data submission.

Full data submission required reporting for a full, continuous 90-day period or up to the full year during the 2017 reporting period and only required measures to maximize the changes to qualify for the 4% positive adjustment. Beginning in 2019,

Full data submission clinicians will be eligible for the performance bonus payment and an exceptional bonus payment.  The exceptional performance bonus is an annual pool of $500,000,000 incentive dollars that are allocated to clinicians who are part of the top tier of MIPS participants in a given performance year.

The exceptional performance payment adjustment is on top of the payment adjustment and is capped at 10% of your Medicare Part-B Billings.

MIPS Payment Adjustment

Partial data submission requires clinicians to submit a minimal amount of data to avoid a negative payment adjustment or a potential positive payment adjustment in 2019.

To maximize your positive payment adjustment for 2020, physicians may submit partial MIPS data or full MIPS data. For partial MIPS data, physicians must submit data for at least 90 days during the 2018 reporting period for Improvement Activities and Advance Care Information performance categories along with a full year of Quality data to receive a possible positive payment adjustment. To fully maximize their MIPS payments, physicians must submit full data by meeting all reporting requirements for the full year during the 2018 reporting period. There is an opportunity for the a maximum positive payment adjustment of 5 percent in 2020. Exceptional performances are eligible for additional bonus adjustment of up to 10 percent.

Implement a Certified Electronic Health Record (EHR)

To maximize the Advancing Care Information (ACI) performance category an eligible clinician participating in MIPS use a certified EHR technology (CEHRT) Physicians will be awarded a bonus score for the use of CEHRT to complete certain activities in the improvement activities performance category and for reporting to public health or clinical data registries. For more details, physicians should visit the Quality Payment Program website at https://qpp.cms.gov/mips/advancing-care-information

To check if your EHR is a certified vendor you can look-up your current EHR vendor at the HealthITGov site

Become a Patient Centered Medical Home (PCMH)/ Patient Centered Specialty Program (PCSP)

Under MIPS, CMS acknowledges both NCQA’s PCMH and PCSP Recognition programs as ways to receive MACRA credit. Clinicians in NCQA-Recognized PCMHs/PCSPs automatically earn full credit in the MIPS Improvement Activities (IA) category.  The IA category accounts for 15% of the final MIPS score so gaining full credit under PCMH/PCSP creates value. 

NCQA (below is from the above source – how should we source this or do we need tool) provided information on the positive impact of PCMH/PCSP to the other performance categories including:

Quality Measures NCQA’s PCMH and PCSP programs increase the use of high-value care, including prevention and good chronic care management and actively promotes quality improvement that will be reflected in MIPS quality measures. 
Advancing Care Information Recognition emphasizes coordination of care and the use of HIT to share care information.
Resource Use Measures A growing body of scientific evidence shows that the PCMH model is saving money by reducing hospital and emergency department visits, mitigating health disparities and improving patient outcomes.

If a practice is not or does not want to become a NCQA PCMH/PCSP but wants to maximize the IA category the practice can focus on several key areas.  Since you must demonstrate that you are doing the clinical practice improvement categories for at least 90 days; physicians should evaluate the inventory of Improvement Activity measures with a lens for what the practice is already doing to improve beneficiary engagement, patient safety and care coordination

Target the Quality Performance Category

The Quality category accounts for 60% of 2017 score and 50% of the 2018 score. MIPS eligible clinicians must submit data on six measures, including at least one outcome measure, for the full calendar year in the 2018 reporting year. Clinicians can select measures individually or report from a specialty-specific measure set. 

Clinicians have the ability to submit more than six measures.  The final MIPS score for the quality domain is based on the practices six highest scoring measures so its offers an advantage to submit more than the required six measures.

Select
Select Outcomes

  • Select at least one outcomes measure.  If no outcome measure applies to the clinician, he or she would report one “high priority measure.”
  • Select measures that apply to the clinicians specialty
  • Select measures with benchmarks so the practice can monitor performance
  • Select measures the practice previously performed well in
     
  • Maximize bonus points by reporting additional high priority measures

    CMS will award:
    • Two bonus points for each additional outcome measure reported beyond the required one
    • Two bonus points for each patient experience measure reported
    • One bonus point for each appropriate use, efficiency, patient safety, or care coordination measure.

    Bonus points for reporting additional “high priority” measures are capped at 10% of the total available points in the Quality performance category for providers. Bonus points will be awarded to applicable measures for the first transition year, even if the provider fails to meet the case minimum or data submission thresholds.
     
  • Leverage electronic reporting bonus points
     
    Physicians who report quality measures through electronic submissions have the opportunity to earn bonus points. Providers may earn up to 10% of the total available points in the Quality performance category if they submit measures through CEHRT or qualified clinical data registry. Each measure submitted electronically through CEHRT or qualified data registry will receive one bonus point. Electronic bonus points are awarded in addition to bonus points for additional high priority measures.

Note: An evaluation of the practices Quality Review and Utilization Report (QRUR) give you information that can help the practice maximize payments under MIPS.  The Quality and Resource Use Report (QRUR) illustrates to clinicians how reimbursement under Medicare Part B fee for service (FFS) will be adjusted based on quality and cost.  It is a good proximity to evaluate the specific metrics related to the clinicians quality and cost performance. To access your QRUR report it is available at the TIN level and accessed via the CMS Enterprise Portal by authorized individuals.

CMS provides QRURs as a means to help physicians and groups understand the care they deliver to Medicare beneficiaries and identify opportunities for improvement in that care. The QRUR performance measure that the practice is currently underperforming in (above the average benchmark) can be targeted for improvement.  Once the practice identifies the areas of opportunity, the practice can use a systematic Clinical Improvement approach.

Characteristics of MACRA Evaluation and Monitoring Tool

The ability to estimate the practices MIPS score is important and there are numerous MIPS and ACO evaluation and monitoring tools on the market today.  When evaluating tools for MIPS performance there are several considerations the practice can consider including the ability to:

  • evaluate overall performance for the population for ACO quality measures and MIPS quality measures
  • real-time, online-performance monitoring by clinician, practice and payer
  • real-time visualization of quality and financial performance
  • drill-down into each MIPS Quality or ACO Quality measure to determine performance
  • drill-down to a patient level to identify the patients that need attention
  • evaluate physicians performance and drill down into providers patients
  • support MIPS scenario modeling to determine score based on selection of different measures
  • assess performance including benchmarking, to target performance improvement
  • track areas of improvement based on practice and clinician baseline
  • assess trends on clinical, regulatory, and financial outcomes
  • assess financial outcomes based on targeted benchmarks

Advanced APM

In the beginning years of the program, most physicians will participate in the QPP using the Merit-based Incentive Payment System (MIPS) pathway. However, over time, it is expected that more physicians will transition to the Advanced Alternative Payment Model (APM) pathway as they become more familiar with the Advanced APM options and as CMS makes more Advanced APMs available.

To qualify for the 5 percent APM incentive payment and the higher annual baseline payment increase for participating in an Advanced APM, an eligible clinician must be a Qualifying APM Participant (QP). An eligible clinician is a QP for a year if the eligible clinician is in an APM Entity group that collectively receives a certain percentage of payments for covered professional services or sees a certain percentage of patients through the Advanced APM during the performance year.  As such, eligible clinicians will want to ensure they are meeting these threshold levels of payments or patients through Advanced APMs to qualify as a Qualifying APM Participant (QP).  Eligible clinicians will also want to ensure they are maximizing incentive payments by providing high quality, cost-efficient care.

A good resource on Advanced APM participation is Building Blocks for Success: Key Considerations for Advanced Alternative Payment Model (APM) Participation

Identify Growth Strategies to be a Qualifying APM Participant (QP)

Grow Advanced APM PCP Network

Many Advanced APMs can grow their payment or patient count by targeting PCPs that can be included in the network.  But it is important to note that not all PCP’s are created equal; expansion should target high-performing PCPs.

Manage Referrals

Practices need to ensure patients do not “leak” to providers outside the Advanced APM network.  Referring physicians can be provided with information that allows them to make a decision on which specialist in the network can provide high quality, cost-efficient care.  

Engage Payers

Practices need to develop a payer strategy – commercial, Medicare Advantage, and Medicaid – that identifies payers that provide the opportunity to move from the traditional fee-for-service contracts to value-based (Advanced APM) contracts.  The result will be increase payment and patient counts that will help meet the QP threshold in coming years.

Payers are selective in entering into APM agreements because they are ultimately accountable for managing the clinical and financial risk.  From that perspective, many times payers will offer resources and analytic insights to support their practice partners in successfully managing the population. Each payer will have their own financial contract model and quality measures; but most are following the lead of the CMS APM models. 

Engage Employers

Employers - the largest purchasers of commercial insurance – are starting to develop direct provider relationships using APM models.  Many large employers are creating bundled payment relationships around specific conditions to lower the cost of care.  In addition, there are some employers looking to contract directly with ACOs to manage the population. 

Create an Advanced APM Opportunity Analysis

As practices move into the Advanced APM payment track, it will be important to identify areas of opportunity to lower costs, improve quality, and increase patient satisfaction.  The opportunity analysis should outline targeted areas of improvement and identify the potential improvement in cost or quality. 

Key areas for improvement include:

  • Network Optimization
  • Leakage and Referral Management
  • Condition Management
  • High-Risk Patient Management
  • Evidence-Based Care Management
  • Inpatient and ER Utilization Management
  • Post-Acute Care Network Management

As these opportunities are identified, they should be incorporated into the financial model to support sensitivity analyses and scenario modeling. 

In addition, a Clinical Improvement Plan can be created to address areas to improve clinical outcomes.

Develop an Advanced APM Financial Model and Plan

The financial fundamentals shift as practices move from a FFS Model to an Advanced APM. The revenue sources, profit drivers, and profit centers shift will drive fundamental change in the operating economics of providers; and practices entering into Advanced APM agreements need to refine how they approach financial modeling and planning. Profitability and market share will hinge on number of lives effectively managed, rather than total volume / breadth of service.

  FFS Model Advanced Payment Model
Revenue sources Utilization-based (volume) fee-for-service reimbursement Total cost of care-based fee-for-value reimbursement (gainsharing, risk share, capitation)
Profit drivers

Procedure-focused model
High volume, full capacity

Cost-effective management of attributable lives
Profit centers Acute facilities dominate the market and drive the most value

Primary care, post-acute care settings become more prominent
Population health managers assume market control

The model and plan should answer the following:

  • Model payment and patient counts across different payer scenarios to meet QP requirements in coming years
  • Define inpatient and outpatient optimization opportunities based on operational benchmarks
  • Model market share and population impacts on utilization and capacity
  • Define risk-model (i.e. risk-share, bundled payments) strategies and scenarios
  • Define total cost of care provided to different populations
  • Define population-based financial forecast including resource requirements, capital, and costs.
  • Ability to incorporate specific assumptions driving performance projections including market dynamics, network size, and cost reduction opportunities
  • Model a range of scenarios and high level outcomes
  • Perform sensitivity analysis for the preferred alternative to understand key pressure points

Develop a Capabilities and Gap Analysis  

A capabilities and gap analysis is key to the success of an APM and Advanced APM.  The practice should examine its current capabilities, strengths and weaknesses.  The analysis should focus on the following required characteristics provider organizations need to be successful as an Advanced APM: strong leadership, clinical integration, successful medical management programs and experience with managing risk, measurement, reporting and incentives.  The analysis should evaluate the partners’ readiness to succeed in an Advanced APM agreement based on the CMS quality and cost requirements. 

Develop a Capabilities and Gap Analysis

Step 1: Define End-State Capabilities

The first step is to ensure an understanding of the end-state capabilities needed for success in an Advanced APM.  Using the information outlined in the Identify Capabilities section, define a capabilities vision and prioritize the capabilities needed to achieve the vision.

Step 2: Assess Current Capabilities

The second step, the current state analysis, is initiated by evaluating each organization’s capabilities based on a construct of the end state. This is accomplished through interviews with key stakeholders, tours of facilities, and surveys.   It will be important that each organization designates clinical and operational leadership to coordinate and guide the process. 

The Capabilities Assessment offers practices a self-evaluation of their current capabilities.  The assessment is structured based on 8 key competencies and outlines strengths and weaknesses. 

Capabilities Assessment

Step 3: Develop Capabilities Gap Analysis

Based on the information obtained in Step One and Two, the practice can create a gap analysis to define the opportunities and overlap, to help ensure effective and efficient use of resources. Often referred to as a 'needs analysis,' the gap expresses needs in the areas of processes, resources, systems, practices, and performance measures.  The gap analysis is an overarching strategic analysis of the capability requirements for the transformation to an Advanced APM.

MIPS APM

MIPS APMs are a hybrid between the MIPS payment track and the Advanced APM payment track. Physicians participating in these APMs will be assessed based on the four MIPS performance categories and subject to payment adjustments under MIPS. However, physicians will be scored using a special APM scoring standard wherein different weights are assigned to the performance categories that are more favorable for participants of these APMs when calculating the composite score.

Determine MIPS APM Participation

Physicians will first need to determine if they are in a MIPS APM.  Use the following assessment from the Physicians Advocacy Institute to help determine if you are in a MIPS APM:

  1. Are you participating in an APM through an APM Entity (e.g, an ACO for Medicare Shared Savings Program Track 2)?
  2. If you are participating in an APM, review the list of the Advanced APMs available for 2018 to determine if the APM you are participating in is considered an Advanced APM:
    • Comprehensive ESRD Care Model (CEC) - Large dialysis organization (LDO) arrangements and Non-LDO two-sided risk arrangements
    • Comprehensive Primary Care Plus (CPC+) Model
    • Medicare Shared Savings Program Accountable Care Organizations (MSSP ACOs –Tracks 1+, 2 & 3)
    • Next Generation ACO Model
    • Oncology Care Model (OCM) - Two-sided risk arrangement
    • Comprehensive Care for Joint Replacement (CJR) Payment Model - Track 1 – CEHRT
    • Vermont Medicare ACO Initiative (as part of the Vermont All-Payer ACO Model)
    • Bundled Payments for Care Improvement Advanced Model (BPCI Advanced)
  3. If you are in an Advanced APM, you will need to make sure you are on the APM Entity’s Participant List, and the APM Entity will receive one of the following determinations which will be applied to you at the individual level:
    1. QP – exempt from MIPS participation (including MIPS APM)
    2. PQ – the APM Entity could elect to participate in MIPS using the MIPS APM scoring standard
    3. Neither QP or PQ – subject to MIPS participation using the MIPS APM scoring standard
  4. If you are in an APM that is not an Advanced APM, review the list of MIPS APMs available for 2018 to determine if the APM you are participating in is considered a MIPS APMs:
    • CEC - LDO arrangements and Non-LDO one- and two-sided risk arrangement 
    • CPC+
    • MSSP ACOs – Tracks 1, 1+, 2, & 3
    • Next Generation ACO Model
    • Oncology Care Model - one- and two-sided risk arrangements
    • Vermont Medicare ACO Initiative (as part of the Vermont All-Payer ACO Model)
    • Bundled Payments for Care Improvement Advanced Model (BPCI Advanced)
      See CMS’s complete list of Advanced APMs and MIPS APMs.
  5. If the APM is listed as a MIPS APM, then you will be subject to the MIPS APM scoring standard.
  6. If the APM is not listed as a MIPS APM, then you are subject to standard MIPS participation.

Investigate Participation in an APM or Advanced APM

Physicians not participating in an APM or Advanced APM may want to consider participating in an APM or Advanced APM.  APMs are part of a broader push to reform the healthcare system to embrace innovative approaches to improve the quality and value of the care delivered with a focus on better care, smarter spending, and healthier people.  APMs work toward these goals through payment arrangements that go beyond fee-for-service billing and give incentive payments to provide high quality, cost-efficient care.  Examples of APMs can include accountable care organizations, patient-centered medical homes, bundled payment models, and episode and condition-based models.  Advanced APMs are a subset of APMs, and let practices earn more for taking on some risk related to their patients' outcomes and cost of care.

Smaller practices will be challenged to develop an APM or Advanced APM based on the time and investment required to implement all the required clinical, technical, and financial capabilities.  Joining or partnering with an existing APM or Advanced APM may be the right path for smaller practices.

Questions for a Practice to Consider Before Joining or Partnering with an Existing APM or Advanced APM
Deciding to participate in an APM or Advanced APM is not a decision to be taken lightly.  There are several questions a practice should consider before joining or partnering with an existing APM or Advanced APM:

  • What are the dynamics of the health care market?
  • What is the impact of the dynamics to my practice both long-term and short-term?
  • How does the design of an APM align with my values and vision?
  • What is my practice looking to achieve by joining an APM?
  • What is the required investment?
  • Is my practice financially viable without an APM?
  • Do my quality outcomes set me up for success in an APM?
  • How does my practice fit into the APM models based on my specialty?
  • Do I have a history of working well with others?

APM and Advanced APM Look-up
For physicians seeking to join an APM in the area, CMS offers the ability to look up APM models by type of model and state. 

Performance Year 2018 Medicare Shared Savings Program Accountable Care Organizations

Other Alternative Payment Models
 
 

Questions to ask the APM
As clinicians evaluate joining an APM – ACO, bundled payment - there are several questions they need to ask to assess if there is a good fit for the practice.  Initially the practice needs to assess their own situation and the catalyst for joining the APM including:

Download and Print ACO Evaluation Questions

Governance and Culture
  • Who are the owners of the ACO? Is it a hospital- or physician-based ACO?
  • How long has the ACO been in existence?
  • What is the size of the network?  What is the ratio of primary care physicians to specialists?
  • What is the governance structure of the ACO - Board, Committee Structures, Physician Leadership?
  • What will the practice be required to do to participate in the ACO?
  • What areas will the practice maintain autonomy?
  • Will the practice have a voice in decision making? 
Payer Contracts
  • What payers - commercial, Medicare, Medicaid - are contracted with the ACO?
  • What is the current membership of the ACO?
  • Will the ACO be able to capture more patients for my practice?
  • What was the previous years’ performance of the ACO by market?
  • What is the long-term financial viability of the ACO?
  • Will my practice get access to better value-based or performance-based contracts?
Performance Management (Clinical and Financial)
  • How does the ACO develop performance measures?
  • Is the quality and clinical improvement committee led by physicians/clinicians?
  • Does the ACO have specific improvement initiatives?
  • Is there support for my practice for improvement activities?
  • How is the information captured for performance measurement?
  • Does the ACO have performance management tools available for my practice?
Payments/Incentives
  • What are the payment models utilized by the ACO - one-sided risk, two-sided risk, capitation?
  • What type of risk-methodology and tools are in place to manage financial and clinical risk?
  • What is the ACO’s current incentive model?
  • How are the shared savings payments calculated by the ACO?
  • Does the payment model create down-side risk for my practice?
  • Do the payers pay for care management on top of other medical services?
Technology
  • What technologies has the ACO invested in since inception? What are the future investment plans?
  • Will my practice be required to utilize their EHR? Does my practice get access to a certified EHR? At what cost?
  • What data will my practice be required to share or send to the ACO?
  • How is information shared across ACO providers?
  • What data management capabilities are in place for sharing, receiving, and managing data?
Care Management and Care Delivery
  • What is the ACO’s approach to population health/care management?
  • How does the ACO identify at-risk patients?  How will I receive the information?
  • Does the ACO offer evidence-based clinical protocols?  Does my practice have to adhere to the protocols?
  • What additional resources are offered to my practice for care management?
  • Does the care management model focus on a centralized or practice-based model?
  • What type of capabilities and data will my practice receive to help better manage a patient or population?
  • Can the ACO help me become a Patient Centered Medical Home? 
  • What is the referral management process? Will my practice have the ability to continue to refer to the specialist I have worked with?

For practices looking to join, it is important to assess the performance of the ACOs in the local area.  CMS provides a yearly report on the performance of ACOs (https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/MSSP-ACO-data.pdf)

Maximizing the APM Scoring Standard

Physicians in a MIPS APM will be scored using a special APM scoring standard wherein different weights are assigned to the performance categories that are more favorable for participants of these APMs when calculating the composite score.  These weights are as follows: 

  • Quality – 50%
  • Improvement Activities – 20%
  • Advancing Care Information – 30%
  • Cost – 0%

Physicians should understand the APM special scoring standard and how they can maximize their scores.  Below are CMS resources on the APM special scoring standard:

  • 2018 Quality Performance Category Scoring for APMs:  This document describes the APM scoring standard for the quality category for MIPS APMs.  It summarizes the regulatory requirements for 2018 APM scoring; describes the quality measures from APMs that are MIPS APMs in the 2018 performance period; and describes the standardized APM scoring methodology for these MIPS APMs that accommodates differences in their quality reporting requirements.
  • 2018 Other MIPS APM Quality Performance Category:  This document presents the APM scoring standard for the Comprehensive End-Stage Renal Disease (ESRD) Care (CEC) Model, the Comprehensive Primary Care Plus (CPC+) Model, and the Oncology Care Model (OCM), collectively referred to as “Other MIPS APMs” in 2018.
  • Performance Year 2018 Quality Performance Category Scoring Web Interface Reporters under the APM Scoring Standard:  This resource shows two MIPS Quality performance category scoring scenarios for MIPS Groups submitting quality measure data via the Web Interface and for eligible clinicians participating in Accountable Care Organizations (ACO) in the Medicare Shared Savings Program or Next Generation ACO Model.  These scoring scenarios are for the 2018 performance year and illustrate how an eligible clinician’s score is calculated including the minimum number of points that can be achieved compared to the maximum number of points (or perfect score), assuming complete and accurate reporting and meeting minimum case size for each measure.
  • Scores for Improvement Activities in MIPS APMs in the 2018 Performance Period:  This resource shows the improvement activities performance category score CMS will assign participants in each MIPS APM for the 2018 performance year.