Operationalizing MACRA QPP MIPS Through the Medical Home

The intent of MACRA’s Quality Payment Program (QPP) is to coordinate patient-centered care across the continuum in a safe, quality manner with good outcomes and controlled costs. The program offers several options to begin or perfect steps leading to this effort to high quality, efficient care supported by technology.

Practices can participate in an Advanced Alternative Payment model (AAPM). Advanced APMs are a subset of APMs, and allow practices to earn more for taking on some risk related to their patients' outcomes. You may earn a 5% incentive payment through an Advanced APM (See the CMS QPP website for the 2017 listing of APM).

The Merit-based Incentive Payment System (MIPS) is another option for participation in Macra QPP. MIPS calculates four domains, three of which are reported on in 2017. Cost will be calculated by CMS, but will not count as part of the composite score in 2017. The three reported domains are:

1. Quality score is 60% of total composite score for 2017
2. Improvement activities (IA) are 15% of total composite score for 2017
3. Advancing care information (AI) is 25% of composite score for 2017

MIPS APM eligible clinicians or groups are clinicians in an APM such as Medicare Shared Savings track 1. These groups hold their participants accountable for the cost and quality of care provided to Medicare beneficiaries. These clinician or groups identify as a “MIPS APM,” and participants in MIPS APMs receive special MIPS scoring under the “APM scoring standard".

If a practice is already a recognized or certified medical home, comparable specialty practice or APM designated as a Medical Home Model, they will automatically earn full credit for the improvement activities category of MIPS.

Achieving medical home recognition or certification will place your practice in an excellent position to achieve all other categories for MIPS reporting, for example:

MIPS Category Advancing Care information (ACI) measures correlate with NCQA 2014 PCMH standards which are:

• Electronic prescribing
• Patient electronic access
• Health information exchange
• Care coordination through patient engagement
• Participation in public health immunization and clinical data registries
• Protection of patient health information

*Quality measures for MIPPS QPP are captured in 2014 standards 6A and 6C*

• Measures Clinical Quality Performance
• Measures Resource Use and Care Coordination
• Measures Patient/Family Experience
• Implements Continuous Quality Improvement
• Demonstrates Continuous Quality Improvement
• Reports Performance
• Uses Certified EHR Technology

Cost reporting, while not calculated for 2017 MIPS reporting, is part of the practice analysis with Cost standard 6B 1&2 in NCQA PCMH standards*

• Select at least two measures related to care coordination
• Select at least two measures affecting your health care costs
   

As we move to value-based models of care and value based contracting, developing a medical home program will give practices the tools necessary to operationalize MIPS or other quality programs required for success.

For more information on the MGMA Consulting and its services, visit our website.

*NCQA will come out with updated PCMH standards in March 2017 and will remain closely aligned to MIPS QPP.