Published: October 5, 2016

FACT SHEETSPost-SGR Payment Policy: MIPS

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law April 16, 2015. MACRA replaced the Sustainable Growth Rate (SGR) and created the Merit-based Incentive Payment System (MIPS) and the Alternative Payment Model (APM) program. Under MIPS, eligible clinicians (ECs) will report on four categories that will add up to a composite performance score. The composite performance score will be used by CMS to determine whether or not an EC will receive a bonus pay­ment or will be subject to a payment reduction. CY 2019 payment adjustments will be based on CY 2017 reporting. ADVANCING CARE INFORMATION (ACI) 25% of the total score in 2019 Replaces the Medicare Electronic Health Record (EHR) Incentive Pro­gram for clinicians. In the future, Academy Members participating in Regent℠ will be able to report ACI through Regent. RESOURCE USE 10% of the total score in 2019 Replaces the cost component of the Value-Based Payment Modifier (VM) Program. The score is based on Medicare claims, meaning no direct reporting requirements for clinicians. QUALITY 50% of the total score in 2019 Replaces the Physician Quality Reporting System and the quality component of VM. Physicians select 6 measures to report (including 1 outcome/high priority measure, and 1 cross-cutting measure). CLINICAL PRACTICE IMPROVEMENT ACTIVITIES (CPIA) 15% of the total score in 2019 Clinicians select from a list of over 90 ac­tivities to receive credit for this category. Can report for CPIA through a qualified registry, an EHR system, a QCDR such as Regent℠, or the CMS web interface and attestation data submission. We have established Regent℠, a qualified clinical data registry (QCDR), which will: Help Members navigate evolving payment models and quality programs Focus on longitudinal perspective of clinical care Inform healthcare at a national level through clinical research Assist with satisfying Maintenance of Certification needs for Members House measures across all specialties of otolaryngology-head and neck surgery To learn more visit, www.entnet.org/content/alternative-payment-models. Download a pdf of “Post-SGR Payment Policy: MIPS.”

MIPS_PieChartThe Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law April 16, 2015.

MACRA replaced the Sustainable Growth Rate (SGR) and created the Merit-based Incentive Payment System (MIPS) and the Alternative Payment Model (APM) program.

Under MIPS, eligible clinicians (ECs) will report on four categories that will add up to a composite performance score. The composite performance score will be used by CMS to determine whether or not an EC will receive a bonus pay­ment or will be subject to a payment reduction. CY 2019 payment adjustments will be based on CY 2017 reporting.

Advancing_Care2 ADVANCING CARE INFORMATION (ACI)
25% of the total score in 2019
  • Replaces the Medicare Electronic Health Record (EHR) Incentive Pro­gram for clinicians.
  • In the future, Academy Members participating in Regent℠ will be able to report ACI through Regent.
Resource_Use2 RESOURCE USE
10% of the total score in 2019
  • Replaces the cost component of the Value-Based Payment Modifier (VM) Program.
  • The score is based on Medicare claims, meaning no direct reporting requirements for clinicians.
Quality2 QUALITY
50% of the total score in 2019
  • Replaces the Physician Quality Reporting System and the quality component of VM.
  • Physicians select 6 measures to report (including 1 outcome/high priority measure, and 1 cross-cutting measure).
Clinical_Practice2 CLINICAL PRACTICE IMPROVEMENT ACTIVITIES (CPIA)
15% of the total score in 2019
  • Clinicians select from a list of over 90 ac­tivities to receive credit for this category.
  • Can report for CPIA through a qualified registry, an EHR system, a QCDR such as Regent℠, or the CMS web interface and attestation data submission.

We have established Regent℠, a qualified clinical data registry (QCDR), which will:

  • Help Members navigate evolving payment models and quality programs
  • Focus on longitudinal perspective of clinical care
  • Inform healthcare at a national level through clinical research
  • Assist with satisfying Maintenance of Certification needs for Members
  • House measures across all specialties of otolaryngology-head and neck surgery

To learn more visit, www.entnet.org/content/alternative-payment-models.

Download a pdf of “Post-SGR Payment Policy: MIPS.”

More from October 2016 - Vol. 35, No. 9
SGR_Pmt_Table-APM
FACT SHEETSPost-SGR Payment Policy: APMs
MACRA replaced the Sustainable Growth Rate (SGR) and created the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) program. The proposed start date for the Advanced APM program is January 1, 2017.
MIPS_ATMS-table
FACT SHEETSMIPS and APMs
MACRA replaced the Sustainable Growth Rate (SGR) and created the Merit-based Incentive Payment System (MIPS) and the Ad­vanced Alternative Payment Model (APM) program. The proposed start date for the two new payment programs is January 1, 2017.
1-MIPS_and_APMs
FACT SHEETSMerit-based Incentive Payment System (MIPS) and eligible Alternative Payment Models (APMs)
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repealed the SGR and created two new payment update tracks: the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).
Academy, Anthem revise SPECT/CT fusion imaging policy
Thanks to Academy physician leaders’ comments and clinical recommendations, Anthem revised the Anthem Medical Policy for Single-Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) Fusion Imaging.
RegentSM is growing
Join the first ENT Clinical Data Registry and be ready for 2017 MIPS reporting
Academy comments on 2017 Medicare Physician Fee Schedule
On July 15, the Centers for Medicare & Medicaid Services (CMS) posted the proposed Medicare physician fee schedule (MPFS) for calendar year (CY) 2017. In addition to payment policy and payment rate updates, the MPFS addresses a number of issues affecting otolaryngologist-head and neck surgeons.
REQUIRED SUBMISSIONAnswering a ‘Call for Papers,’ applying for a grant, or engaging in committee work?
All Scientific Oral Presentations at the AAO-HNSF Annual Meeting and all manuscripts resulting from Academy or Foundation-sponsored research or committee work must be submitted as full-length articles to Otolaryngology–Head Neck Surgery, the official journal  of the AAO-HNSF, for right of first refusal.
statements
Committees and 3P Workgroup approve nine Position Statements
At the September Board of Directors Meeting, nine Position Statements (three of which were new) were approved for use in state and federal regulatory or advocacy efforts, or to clarify the AAO-HNS/F approval or disapproval of certain practices in medicine.
Lokman B. Saim, MD
AAO-HNSF establishes two international awards
Thanks to the generosity of Nikhil J. Bhatt, MD, the AAO-HNSF has established the AAO-HNSF Nikhil J. Bhatt, MD International Humanitarian Award and the International Public Service Award. These awards were announced during the AAO-HNS/F Boards of Directors’ luncheon, September 17.
A team of surgeons from Virginia Commonwealth University performed the first cochlear implant in Barbados in May.
Revamping hearing health in BarbadosExpanded from the print edition
Here in the United States, universal newborn hearing screening has become so prevalent and successful that we nearly take it for granted that children with hearing loss will be identified and treated. For the few children who slip through the cracks, the consequences are substantial and the feelings of failure are real.
ishman
BOARD OF GOVERNORSBe an advocate for change
The joy of patient care is hopefully something that you experience on a regular basis. As practitioners, it is easy to get caught up in the alphabet soup—MIPS, MACRA, ACA, EHR. But, the real reason that most of us chose this path is the patients.
James C. Denneny III, MD AAO-HNS/F EVP/CEO
Commitment and collaboration
Even the most casual observer who attended our meeting in San Diego would recognize the massive amount of work that goes into staging our Annual Meeting. The teamwork between our staff and otolaryngologists worldwide and spectrum of practice situations is truly amazing.
Gregory W. Randolph, MD AAO-HNS/F Past President
The Academy is our calling
As a third-year Cornell Medical College student I had a basic science research background and strong clinical interest in reproductive endocrinology. It was then I took my otolaryngology-head and neck surgery rotation and met Roy Sessions, MD, then the sole otolaryngologist on the renowned head and neck surgical service of Memorial Sloan Kettering.