Congress, through the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) (P.L. 114-10), has recognized the importance of small and rural medical practices and provided funding for their assistance in navigating the new Medicare Quality Payment Program (QPP). To this end, CMS has announced the award of approximately $20 million to 11 organizations for the first year of a five-year program to provide on-the-ground training and education about the QPP. The program is for individual clinicians or small group practices of 15 or fewer clinicians. CMS also intends to invest up to an additional $80 million over the remaining four years of the program.
The Quality Payment Program
MACRA ended the sustainable growth rate formula, which threatened clinicians participating in Medicare with potential payment cliffs for 13 years. The QPP improves Medicare by helping practices focus on care quality. The QPP has two tracks to choose from: (1) the Advanced Alternative Payment Models (APMs); or (2) the Merit-based Incentive Payment System (MIPS). If a practice decides to participate in an Advanced APM, through Medicare Part B, it may earn an incentive payment for participating in an innovative payment model. If it decides to participate in MIPS, it will earn a performance-based payment adjustment.
A practice is part of the QPP in 2017 if it is in an Advanced APM or if it bills Medicare more than $30,000 a year and provides care for more than 100 Medicare patients a year. If a practice is below either threshold, it is not in the program. For MIPS, the practice must also be a physician, physician assistant, nurse practitioner, clinical nurse specialist, or a certified registered nurse anesthetist.
Training and education effort
The training and education contracts have been awarded to the following organizations: Altarum; Georgia Medical Care Foundation (GMCF); HealthCentric; Health Services Advisory Group (HSAG); IPRO; Network for Regional Healthcare Improvement (NRHI); Qsource; Qualis; Quality Insights (West Virginia Medical Institute); Telligen; and TMF Health Quality Institute.
These 11 organizations will provide hands-on training to help thousands of small practices, especially those that practice in historically under-resourced areas including rural areas, health professional shortage areas, and medically underserved areas. The training and education resources will be available immediately, nationwide, and will be provided at no cost to eligible clinicians and practices. The organizations will provide customized technical assistance to clinicians and practices. For example, clinicians will receive help choosing and reporting on quality measures, as well as guidance with all aspects of the QPP, including supporting change management and strategic planning and assessing and optimizing health information technology.
Other free training and education
CMS reports that thousands have received free training and education through webinars and in-person training from CMS staff since the QPP Final Rule was released last October (see MACRA final regulations reflect input from ‘months-long listening tour’, October 14, 2016).
In addition, every clinician in the QPP can receive in-person training through the established Quality Innovation Networks, the Transforming Clinical Practice Initiatives, and the Alternative Payment Model Learning Systems.