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  • CMS Alternative Payment Models

    Posted by tdetlie_105 on July 22, 2017 at 2:18 pm

    Forgive my ignorance on this topic but when can we expect this to fully become implemented and feel its impact?  Based on my limited understanding of this concept I think I prefer death by a thousand cuts…

    ruszja replied 2 years, 5 months ago 6 Members · 11 Replies
  • 11 Replies
  • tdetlie_105

    Member
    July 22, 2017 at 7:49 pm

    Guess we are all in the dark on this one 

    • Dr_Cocciolillo

      Member
      July 22, 2017 at 8:13 pm

      around 2020-22 period.  i am not in charge in my group on this but that’s what i recall from seeing prior presentations

      • Smythe84

        Member
        July 23, 2017 at 7:59 am

        Your organizations should already be “reporting” this year for the fee schedule changes which will start in 2019. See the link provided below. Pay close attention to the “MIPS” part. Also, see slide #19 to understand the relevance and impact.
         
        [link=https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program-MIPS-NPRM-Slides.pdf]https://www.cms.gov/Medic…m-MIPS-NPRM-Slides.pdf[/link]
         
        Here is the scoring methodology overview:
        [link=https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MIPS-Scoring-Methodology-slide-deck.pdf]https://www.cms.gov/Medic…odology-slide-deck.pdf[/link]
         
        Quality measures:
        [link=https://qpp.cms.gov/mips/quality-measures]https://qpp.cms.gov/mips/quality-measures[/link]
         
        Improvement activities:
        [link=https://qpp.cms.gov/mips/improvement-activities]https://qpp.cms.gov/mips/improvement-activities[/link]
         
        Advancing care information:
        [link=https://qpp.cms.gov/mips/advancing-care-information]https://qpp.cms.gov/mips/.vancing-care-information[/link]
         
        Implementing these changes will likely require time and capital, esp. if you use some kind of consultation company; however you stand to maintain your medicare fee schedules or potentially have them increased incrementally up to 9%. If you’re in a high volume practice and you have a lot of medicare beneficiaries, you could either lose a lot of money by doing nothing; or could potentially increase your revenue considerably.

        • Smythe84

          Member
          July 23, 2017 at 8:08 am

          OP, were you referring to Advanced payment models (APM) specifically within the Quality Payment Program (QPP)? Or just generally about the overall QPP?
           
          The above links really apply to physicians in the MIPS arm of the QPP (the two arms of the QPP are APM and MIPS). Most rads will fall under the MIPS arm.

          • tdetlie_105

            Member
            July 23, 2017 at 10:07 am

            Quote from iatros

            OP, were you referring to Advanced payment models (APM) specifically within the Quality Payment Program (QPP)? Or just generally about the overall QPP?

            The above links really apply to physicians in the MIPS arm of the QPP (the two arms of the QPP are APM and MIPS). Most rads will fall under the MIPS arm.

             
            Thanks for the detailed response.  My small group does have a billing/consultation company.  We often get coding request to addend reports mainly to do with MIPS I believe.
             
            My understanding/mis-understanding of the APM was that it was a move from traditional fee-for-service and that somehow hospitals/physicians were going to be reimbursed lump sums based on type of patient encounter and it was yet to be determined how these reimbursements would be divide up (with my fear being that we as radiologists would particularly get sh*fted given our lack control over patients that clinicians have).  What am I mixing up?
             

            • mario.mtz30_447

              Member
              January 27, 2022 at 3:47 pm

              Could someone please explain the basic nuts/bolts/rules of MIPS?
               
              I’ve occasionally done searches for info but it doesn’t seem straightforward and I don’t want to spend a lot of time searching for info.
               
              For the average radiology group or radiologist, what are the basic rules?  What kind of ballpark money are we talking about for a group or radiologist potentially gained or lost?
               

              • ruszja

                Member
                January 27, 2022 at 3:52 pm

                Quote from IGotKids2Feed

                Could someone please explain the basic nuts/bolts/rules of MIPS?

                You spend a bunch of energy and money on trying to get your reporting right, and in the end you get 1% less on your medicare billings. The next year, the rules change and you are back to square 1. It’s the ‘tortoise and the hare’, except it’s your money that evaporates.

                • mario.mtz30_447

                  Member
                  January 29, 2022 at 10:06 am

                  Thank you.  Did a little more google searching with this angle.  
                   
                  [link=https://jamanetwork.com/journals/jama-health-forum/fullarticle/2779947]https://jamanetwork.com/j…um/fullarticle/2779947[/link]
                   
                  [b]Participating in the MIPS program results in substantial financial and time costs for physician practices. We found that, on average, it cost practices $12811 per physician to participate in MIPS in 2019.  [/b]We found that physicians themselves spent a considerable amount of time to participate in MIPS. In 2019, physicians spent more than 53 hours per year on MIPS-related activities, which translates to nearly $7000 per physician. If physicians see an average of 4 patients per hour, then these 53 hours could be used to provide care for an additional 212 patients a yearequal to more than a full weeks work for a physician.

                  According to data from the MGMA, average total revenue (not compensation) for a US general surgeon is $543562.[sup][link=https://jamanetwork.com/journals/jama-health-forum/fullarticle/2779947#aoi210008r24]24[/link][/sup] Assuming 21.9% revenue from Medicare fee-for-service (the mean proportion in the study sample),[b] a general surgeon receiving a perfect 2018 MIPS score could expect to receive a reward of approximately $2000 in 2020 [/b](eMethods 2 in the [link=https://jamanetwork.com/journals/jama-health-forum/fullarticle/2779947#note-AOI210008-1]Supplement[/link]). Potential rewards and penalties will increase to approximately 9% by the 2022 payment year, and the performance score required to avoid a penalty will similarly increase with time
                   

                  • Donna.M.Peters_434

                    Member
                    January 29, 2022 at 12:14 pm

                    Use this. At this point, your practice is trying to avoid a 9% penalty if you dont pass which is in addition to any conversion factor, indirect expense revaluation and other cuts.

                    [link=https://www.acr.org/-/media/ACR/Files/Registries/QCDR/2022-MIPS-Measures-Supported.pdf]https://www.acr.org/-/med…Measures-Supported.pdf[/link]

                    • mario.mtz30_447

                      Member
                      January 29, 2022 at 1:02 pm

                      Another piece of the puzzle.  I assume my large group is doing this, I’m just trying to understand more of it.  This helps, thank you.
                       
                      Govt always has to make things so confusing and convoluted.
                       
                      So looks like a practice chooses 6 of these Quality measures for 2022.  Quality is worth a maximum of 40 points (40% of max MIPS score of 100).
                       
                      Don’t understand….  apparently most INDIVIDUAL physicians are not REQUIRED to be involved based on not hitting all three thresholds including $90,000/year allowable charges for Medicare Part B.  But PRACTICES are REQUIRED?
                       
                       

                    • ruszja

                      Member
                      January 29, 2022 at 2:18 pm

                      Quote from IGotKids2Feed

                      Another piece of the puzzle.  I assume my large group is doing this, I’m just trying to understand more of it.  This helps, thank you.
                      .
                      .
                      .
                      Don’t understand….  apparently most INDIVIDUAL physicians are not REQUIRED to be involved based on not hitting all three thresholds including $90,000/year allowable charges for Medicare Part B.  But PRACTICES are REQUIRED?

                      As a rad you are probably way above 90k/year MC-B.

                      Your billing company is probably doing this on the back end. Most of the measures are stupid. Ask the billing company what they report and whether they need you to say some magic words to have your reports qualify (magic words such as ‘following NASCET criteria’ when quantifying stenosis.)