What Mental Health Providers Can Expect From the Quality Payment Program

The Centers for Medicare and Medicaid Services (CMS) has established incentive programs to encourage Medicare providers to go above and beyond to provide quality care. In 2006, CMS introduced the Physician Quality Reporting System (PQRS) to allow providers to report on the quality of care provided to Medicare beneficiaries. Under PQRS, those who did not meet established reporting requirements were subject to a negative payment adjustment to encourage data reporting.

Now, in accordance with the Medicare Access and CHIP Reauthorization Act (MACRA), CMS has ended PQRS and other quality programs (Value-based Modifiers and the Medicare EHR Incentive Program, or Meaningful Use) in favor of the Quality Payment Program (QPP).

The Quality Payment Program

The Quality Payment Program offers a new set of tools to help Medicare providers give clients the highest quality care possible. Like PQRS, QPP encourages providers to submit data to CMS to demonstrate their focus on quality care.

QPP is made up of two tracks: Advanced Alternative Payment Models (APMs) and Merit-Based Incentive Payment System (MIPS). As a mental health provider, you'll likely participate in MIPS, and QPP as a whole is designed to reduce the burden of quality reporting. There are several key differences between PQRS and the MIPS track under QPP:

• Only six quality measures must be reported (PQRS required nine)
• The minimum reporting period is 90 days rather than a full year
• Many measures simply require attestation rather than complex data capture and analysis
• QPP allows for greater variety in the use of technology for data reporting as well as increased technical assistance

One of the most significant differences between the two programs is how payment adjustments are handled. With MIPS, payment adjustments account for both failed and successful reporting:

• Failure to report any data may result in a -4% adjustment
• High-performing submitters (those who submit between 90 days and a full year of data to Medicare) can earn a payment adjustment up to +4%
• By 2022, earning potential will grow to 9%
• CMS has set aside an additional $500 million annually for the first six years of the program to reward exceptional performers above and beyond the expected payment adjustments

Mental health providers including clinical psychologists, clinical social workers, and others are required to begin MIPS reporting in 2019 to avoid negative payment adjustments and reap the highest rewards. Here are some of the many resources available to you to learn more about MIPS and the Quality Payment Program:

• MIPS Participation Fact Sheet
• Quality Payment Program Training Videos
• The Quality Payment Program Resource Library
• Specialized Support for Small, Underserved, and Rural Practices

Keep an eye on our blog for more information about the Quality Payment Program, MIPS, and how TherapyNotes™ can help you under the new program.

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