Payment & Delivery Models

Customizable MIPS tool helps physicians build QPP strategy

Andis Robeznieks , Senior News Writer

How physicians participate and perform in 2017 will affect their Medicare payment rates in 2019, yet a recent survey found that most physicians don’t consider themselves deeply knowledgeable about the Centers for Medicare and Medicaid Services’ (CMS) new Quality Payment Program (QPP).

The AMA has acted on the findings by providing QPP resources on how to participate, avoid penalties and succeed, particularly under the Merit-Based Incentive Payment System (MIPS) track. A new customizable resource, the MIPS Action Plan, helps physicians choose and implement a practice QPP strategy, fulfill regulatory requirements, avoid federal penalties and have an opportunity for performance-based incentive payments.

The MIPS Action Plan addresses key steps for 2017 QPP participation:

  1. Determine whether MIPS applies to you.
  2. Review available performance categories.
  3. “Pick Your Pace” for MIPS participation.
  4. Review your data.
  5. Decide whether to report as an individual or a group.
  6. Identify your reporting mechanism.
  7. Perform a security risk analysis.
  8. Report for at least 90 days (CMS deadline: Oct. 2, 2017).
  9. Complete MIPS performance (CMS deadline: Dec. 31, 2017).
  10. Submit 2017 MIPS data.

Physicians who have yet to participate in the QPP program or are new to quality improvement are encouraged to explore the interactive MIPS Action Plan and other free resources and tools. A more in-depth explanation of these steps is available in a supplementary frequently asked questions file.

On step two, for example, the FAQ file offers advice and strategies on which quality measures to choose.  This includes opting for those that are most representative of your practice, such as ones that apply to the patients you see or the procedures that you perform frequently enough to ensure you have a minimum of 20 cases.

Advice is also given specifically for smaller practices as well as information on meeting minimum requirements to avoid a penalty or earning maximum points.

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Many physicians, still fuzzy on details, feel unprepared for QPP

Carol Vargo, AMA director for physician practice sustainability, recently discussed the survey and AMA QPP-preparation efforts with ReachMD host Matt Birnholz, MD.

“I would say that based on all of our focus groups and all of our conversations with physicians, the most overarching question they have is, ‘What do I need to do today?’” Vargo told Dr. Birnholz during a recent ReachMD podcast. “‘Yes, I want to know about the future but, frankly, just tell me what I need to know right now.’”



Vargo also cited the AMA’s “One Patient, One Measure, No Penalty” campaign. The effort offers resources instructing physicians on how to complete the minimum requirements in order to avoid a 4 percent penalty in 2019. These include an instructional video aimed at busy physicians that clocks in at less than three-and-a-half minutes and a nine-step guide for completing the process.

The resources have been disseminated to the specialty, state and local medical societies in the AMA Federation and many have posted the materials on their own websites.

Many physicians are exempt from MIPS participation because they see 100 or fewer Medicare beneficiaries or their Medicare revenue is less than $30K per year. CMS has a tool where physicians can check their status by entering their ten-digit National Provider Identifier number.

The AMA also has a Payment Model Evaluator tool to help physicians better understand the financial impact QPP may have on their practices.

The AMA’s goals for payment reform include:

  • Giving physicians more resources and greater flexibility to deliver appropriate care to their patients than they have today.
  • Improving the financial viability of physician practices in all specialties, and helping independent practices of all sizes remain independent.
  • Minimizing physician administrative burdens that do not improve the quality of patient care.
  • Enabling physicians to help control aspects of health care spending that they can influence, rather than having Medicare use inappropriate mechanisms to control costs such as payment cuts, prior authorization and/or non-coverage of services.
  • Avoiding transferring inappropriate financial risk to physicians or jeopardizing the quality of patient care.

Other episodes of the AMA-sponsored ReachMD podcast series, “Inside Medicare’s New Payment System,” further examine the impact of the Medicare Access and CHIP Reauthorization Act.