Do 16 or more clinicians work for your practice?
Do they currently report their merit-based incentive payment system (MIPS) quality measures via claims?
If you answered ‘Yes’ to both questions, you might not like
a proposed change to the quality payment program (QPP): CMS wants to limit the claims-based reporting method to small practices in 2019 and beyond. (The QPP section of the rule starts on p. 493 of the linked display copy.)
“As previously expressed in the 2017 Quality Payment Program final rule (81 FR 77090), we want to move away from claims reporting, since approximately 69% of the Medicare Part B claims measures are topped out. While we would like to move towards the utilization of electronic reporting by all clinicians and groups, we realize that small practices face additional challenges, and this requirement may limit their ability to participate. For this reason, we believe that Medicare Part B claims measures should be available to small practices, regardless of whether they are reporting as individual MIPS eligible clinicians or as groups. Therefore, we propose amending §414.1325(c)(1) to make the Medicare Part B claims collection type available to MIPS eligible clinicians in small practices beginning with the 2021 MIPS payment year.”
Practices that fit the definition of small practice this year may grow out of the small practice pool without changing the number of employees. Next year CMS intends to define a small practice as a tax identification number (TIN) “consisting of 15 or fewer eligible clinicians during the MIPS determination period,” the proposed rule states. But, CMS plans to expand the definition of MIPS-eligible clinicians to include:
- Physical therapists.
- Occupational therapists.
- Clinical social workers.
- Clinical psychologists.
This means that in 2018 a hypothetical orthopedic practice with five doctors, seven physician assistants and nine physical therapists under its TIN has 12 MIPS-eligible clinicians and meets the QPP's definition of a small practice. But if the proposed changes go into effect next year, it will have 21 MIPS-eligible clinicians and will not be eligible for any of the small practice exceptions or extras.
If this change sounds like bad news to you, there is some good news: This is a proposed rule and you have until Sept. 10, to comment, and potentially change CMS’ mind. You can submit a comment for the proposed rule — CMS-1693-P — online at
www.regulations.gov.
Be prepared to provide details in your comment. Do some research on the impact switching to another method of reporting — such as registry or electronic health record — would have on your practice and share that information with CMS. For example, if your practice will have to spend money to change your reporting method, provide a reasonable estimate of how much it will cost, then explain how you arrived at that amount and why it would be a significant burden on the practice.
If the switch would require extra time or staff, provide details about the amount of time or the number of employees the practice would need. Again, you need to share details about how you reached that conclusion and how much of a burden it would be on your practice. Or perhaps the claims-based measures benefit your patient population and other reporting methods don’t offer those measures or suitable replacements. The bottom line is practices that will be impacted by this proposal should be prepared to make a clear and compelling case to CMS.