Quality Payment Program Research Articles

MACRA and the Quality Payment Program: How Does It Relate to Orthopaedic Nursing?

The introduction of 2017 also brought with it the beginning of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) legislation related to the Quality Payment Program (QPP), in addition to alternative payment models and the merit-based incentive payment system. The successful implementation of the QPP within the specialty of orthopaedics will rely heavily on the active involvement of orthopaedic nurses when it comes to improving quality, lowering costs, and incorporating value. It is important for orthopaedic nurses to understand the QPP and the role it plays in determining value-based payment of orthopaedic care delivery, in addition to how the structure of the QPP correlates with nursing diagnoses and respective plans of care delivery.

MACRA and the Quality Payment Program: How Does It Relate to Orthopaedic Nursing?

MACRA and the Quality Payment Program: How Does It Relate to Orthopaedic Nursing?

Double Scan CT Rates: An Opportunity for Facility-Based Radiologist Measures in the Quality Payment Program

PurposeThe Medicare Access and CHIP Reauthorization Act (MACRA) provides CMS flexibility to evaluate radiologists using hospital outpatient quality measures in place of conventional physician measures. We explore radiologist characteristics associated with variation in performance in two such measures: abdomen and chest CT “double scan” rates (percentage of total examinations performed both with and without intravenous contrast). MethodsRadiologists’ claims for abdomen and chest CT examinations in a facility setting were identified using 2014 Medicare Physician and Other Supplier data. Individual radiologist double scan rates were computed. Associations were explored between rates and radiologist characteristics extracted from the CMS public data sets using multivariable regression with cross-validation. ResultsRadiologists’ double scan rates averaged 5.9% ± 10.0% (0.0% for 52.8% of radiologists) for abdomen CT (19,867 radiologists) and 1.0% ± 4.7% (0.0% for 91.3% of radiologists) for chest CT (18,684). At multivariable analysis, abdomen rates were best predicted by geography (lowest in Northeast, greatest in West), practice size (greatest for small practices), and specialty practice pattern (lowest for general radiologists; greatest for nuclear medicine physicians). Agreement for double scan rates among radiologists within the same practice was moderate, though slightly higher for chest (intraclass correlation = 0.70) than abdomen (0.59). ConclusionRadiologists’ facility double scan rates vary systematically based on an array of professional characteristics. MACRA grants CMS the authority to use these measures for evaluating radiologists, thereby aligning Medicare’s hospital and physician performance programs and better incentivizing population radiation dose and cost reduction. Greater variation in abdomen CT double scan rates, compared with ubiquitously excellent chest CT performance, supports a particular role for abdomen rates in distinguishing disparities in radiologist performance.

Primary Care Provider Perceptions and Practices Regarding Dosing Units for Oral Liquid Medications

IntroductionTo prevent errors, health care professional and safety organizations recommend using milliliters (mL) alone for oral liquid medication dosing instructions and devices. In 2018, for federal incentives under the Quality Payment Program, one requirement is for electronic health records to automatically use mL alone whenever oral liquid medications are prescribed. Current perceptions and practices of primary care providers (PCPs) regarding dosing units for oral liquid medications were assessed. MethodsPediatricians, family practitioners, nurse practitioners, and internists participating in the 2015 DocStyles Web-based survey were asked about their perceptions and practices regarding dosing units for oral liquid medications. ResultsThree fifths of PCPs (59.0%) reported that using mL alone is safest for dosing oral liquid medications; however, nearly three quarters (72.0%) thought that patients/caregivers prefer instructions that include spoon-based units. Within each specialty, fewer PCPs reported they would prescribe using mL alone than reported that using mL alone is safest (P < .0001 for all). Among PCPs who think milliliter-only dosing is safest, those who perceived patients/caregivers prefer including spoon-based units were less likely to prescribe using mL alone (odds ratio 0.45, 95% confidence interval 0.34–0.59). Pediatricians were more likely than other PCPs to report that it is safest to use mL alone (80.8% vs 54.7%) and that they would use mL alone when prescribing (56.8% vs 30.9%) (P < .0001 for both). ConclusionsBecause less than two thirds of pediatricians and one third of other PCPs would use mL alone in dosing instructions, additional education to encourage prescribing and communicating with patients/caregivers using mL alone may be needed.

CMS Issues Final Rule for Medicare Quality Reporting in 2018

CMS Issues Final Rule for Medicare Quality Reporting in 2018

Oncology Qualified Clinical Data Registry: A Patient-Centered, Symptom-Focused Framework to Guide Quality Improvement .

The Oncology Nursing Society is the steward of seven patient-centered, symptom-focused custom quality measures that have been codified into electronic format to facilitate extraction of data from the electronic health record. Because quality measurement is the cornerstone of the Quality Payment Program for providers in the pay-for-value framework, oncology nurses must be engaged in the quality measurement and improvement activities within their practice sites. .

Benchmarking the American Society of Breast Surgeon Member Performance for More Than a Million Quality Measure-Patient Encounters

BackgroundNine breast cancer quality measures (QM) were selected by the American Society of Breast Surgeons (ASBrS) for the Centers for Medicare and Medicaid Services (CMS) Quality Payment Programs (QPP) and other performance improvement programs. We report member performance.Study DesignSurgeons entered QM data into an electronic registry. For each QM, aggregate “performance met” (PM) was reported (median, range and percentiles) and benchmarks (target goals) were calculated by CMS methodology, specifically, the Achievable Benchmark of Care™ (ABC) method.ResultsA total of 1,286,011 QM encounters were captured from 2011–2015. For 7 QM, first and last PM rates were as follows: (1) needle biopsy (95.8, 98.5%), (2) specimen imaging (97.9, 98.8%), (3) specimen orientation (98.5, 98.3%), (4) sentinel node use (95.1, 93.4%), (5) antibiotic selection (98.0, 99.4%), (6) antibiotic duration (99.0, 99.8%), and (7) no surgical site infection (98.8, 98.9%); all p values < 0.001 for trends. Variability and reasons for noncompliance by surgeon for each QM were identified. The CMS-calculated target goals (ABC™ benchmarks) for PM for 6 QM were 100%, suggesting that not meeting performance is a “never should occur” event.ConclusionsSurgeons self-reported a large number of specialty-specific patient-measure encounters into a registry for self-assessment and participation in QPP. Despite high levels of performance demonstrated initially in 2011 with minimal subsequent change, the ASBrS concluded “perfect” performance was not a realistic goal for QPP. Thus, after review of our normative performance data, the ASBrS recommended different benchmarks than CMS for each QM.

Challenges, Perceptions, and Readiness of Oncology Clinicians for the MACRA Quality Payment Program

This study surveys oncologists, hematologists, and practice administrators to gain an understanding of their perceptions of and readiness to participate in the MACRA Quality Payment Program.

Tips for participating in the Quality Payment Program in 2018 and beyond

Tips for participating in the Quality Payment Program in 2018 and beyond

Correction to: American Heart Association's Call to Action for Payment and Delivery System Reform.

HomeCirculationVol. 136, No. 19Correction to: American Heart Association’s Call to Action for Payment and Delivery System Reform Free AccessCorrectionPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCorrectionPDF/EPUBCorrection to: American Heart Association’s Call to Action for Payment and Delivery System Reform Originally published7 Nov 2017https://doi.org/10.1161/CIR.0000000000000543Circulation. 2017;136:e346This article corrects the followingAmerican Heart Association’s Call to Action for Payment and Delivery System ReformIn the article by Bufalino et al, “American Heart Association’s Call to Action for Payment and Delivery System Reform,” which published ahead of print July 10, 2017, and appeared in the August 15, 2017, issue of the journal (Circulation. 2017;136:e162–e171. DOI: 10.1161/CIR.0000000000000516), a correction was needed.On page e165, in the right column, second paragraph, last sentence, “track 1.5” was changed to “track 1+.” The updated sentence reads, “A new MSSP track 1+, which is yet to be developed but was mentioned in the recent final rule for the Quality Payment Program, will also achieve advanced alternative payment model status.2”This correction has been made to the current online version of the article, which is available at http://circ.ahajournals.org/content/136/7/e162.FootnotesCirculation is available at http://circ.ahajournals.org. Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesAmerican Heart Association’s Call to Action for Payment and Delivery System ReformVincent J. Bufalino, et al. Circulation. 2017;136:e162-e171 November 7, 2017Vol 136, Issue 19 Advertisement Article InformationMetrics © 2017 American Heart Association, Inc.https://doi.org/10.1161/CIR.0000000000000543PMID: 29109204 Originally publishedNovember 7, 2017 PDF download Advertisement

Proposed Quality Payment Program changes for 2018

Proposed Quality Payment Program changes for 2018

Beginner’s Guide to Medicare Access and CHIP Reauthorization Act’s Quality Payment Program

Beginner’s Guide to Medicare Access and CHIP Reauthorization Act’s Quality Payment Program

Centers for Medicare and Medicaid Services (CMS) Quality Payment Program: A New Financial Conflict of Interest for Physicians

Centers for Medicare and Medicaid Services (CMS) Quality Payment Program: A New Financial Conflict of Interest for Physicians

Society Advocacy Continues to Make Impact Amid Uncertainty

Society Advocacy Continues to Make Impact Amid Uncertainty

Quality measures in gastrointestinal endoscopy: the current state.

The purpose of this review is to summarize the current state of endoscopic quality measurement and use of measures in enhancing the value of endoscopic services. Initially, quality measurement of endoscopic procedures was claims based or included small unit or practice-specific efforts. Now we have a mature national registry and large electronic medical or procedural records that are designed to yield valuable data relevant to quality measurement. With the advent of better measures, we are beginning to understand that initial process and surrogate outcome measures (adenoma detection rate) can be improved to provide a better reflection of endoscopic quality. Importantly, however, even measures currently in use relate to important patient outcomes such as missed colon cancers. At a federal level, older cumbersome pay-for-performance initiatives have been combined into a new overarching program named the quality payment program within the centers for medicare and medicaid services. This program is an additional step toward furthering the progress from volume-to-value-based reimbursement. The legislation mandating the movement toward outcomes-linked (value) reimbursement is the medicare access and children's health insurance program reauthorization act, which was passed with overwhelming bipartisan support and will not be walked back by alterations of the affordable care act. Increasing portions of medicare reimbursement (and likely commercial to follow) will be linked to quality metrics, so familiarity with the underlying process and rationale will be important for all proceduralists.

Cost measurement and payment implications in the Quality Payment Program

Cost measurement and payment implications in the Quality Payment Program

CMS Proposes Rule on Implementing Quality Payment Program Under MACRA

CMS Proposes Rule on Implementing Quality Payment Program Under MACRA

MACRA and the Changing Medicare Payment Landscape.

The Medicare Access and CHIP Reauthorization Act (MACRA) is being implemented in 2017 by the Centers for Medicare and Medicaid Services (CMS) as the Quality Payment Program (QPP) and will have important and far reaching effects on how physicians are reimbursed and on how they practice. The QPP modifies the Medicare physician payment system by eliminating the Sustainable Growth Rate formula and incorporating the existing Physician Quality Reporting System, EHR Incentive Program, and the Value Modifier into a single new Merit-based Incentive Payment System (MIPS). The authors reviewed the MACRA legislation as well as the CMS resources on the QPP and other sources to summarize the regulations pertaining to the new program, particularly for the first performance period. CMS has taken great care to create a smooth transition for Medicare physicians. Clinicians can avoid any penalty for performance in 2017 by submitting a minimal amount of quality data, attesting to a single improvement activity, or successfully attaining the base score for the advancing care information portion of MIPS. The reduced reporting period also makes it possible for participants to begin collecting data as late as October 2nd and still achieve the full possible score in the program. Surgeons should be taking steps now to ensure that they are prepared to succeed in the QPP. The transition period creates a clear pathway for avoiding penalties while providing an opportunity to test one's ability to participate and improve performance.

The American Society of Breast Surgeons and Quality Payment Programs: Ranking, Defining, and Benchmarking More Than 1 Million Patient Quality Measure Encounters

BackgroundTo identify and remediate gaps in the quality of surgical care, the American Society of Breast Surgeons (ASBrS) developed surgeon-specific quality measures (QMs), built a patient registry, and nominated itself to become a Center for Medicare and Medicaid Services (CMS) Qualified Clinical Data Registry (QCDR), thereby linking surgical performance to potential reimbursement and public reporting. This report provides a summary of the program development.MethodsUsing a modified Delphi process, more than 100 measures of care quality were ranked. In compliance with CMS rules, selected QMs were specified with inclusion, exclusion, and exception criteria, then incorporated into an electronic patient registry. After surgeons entered QM data into the registry, the ASBrS provided real-time peer performance comparisons.ResultsAfter ranking, 9 of 144 measures of quality were chosen, submitted, and subsequently accepted by CMS as a QCDR in 2014. The measures selected were diagnosis of cancer by needle biopsy, surgical-site infection, mastectomy reoperation rate, and appropriateness of specimen imaging, intraoperative specimen orientation, sentinel node use, hereditary assessment, antibiotic choice, and antibiotic duration. More than 1 million patient-measure encounters were captured from 2010 to 2015. Benchmarking functionality with peer performance comparison was successful. In 2016, the ASBrS provided public transparency on its website for the 2015 performance reported by our surgeon participants.ConclusionsIn an effort to improve quality of care and to participate in CMS quality payment programs, the ASBrS defined QMs, tracked compliance, provided benchmarking, and reported breast-specific QMs to the public.

Quality Payment Program and Quality Measure Benchmarks.

Quality Payment Program and Quality Measure Benchmarks.