Representatives of the American College of Radiology (ACR) are participating in the first two waves of MACRA Episode-Based Cost Measures Clinical subcommittees that are developing episode-based cost measures for Medicare’s Quality Payment Program (QPP).
ACR members are serving on new Wave 2 clinical subcommittees for oncology, urology and musculoskeletal disease management. The Centers for Medicare & Medicare Services (CMS) tasked the subcommittees to develop care episode and patient condition groups for use in cost measures to meet the requirements of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The work of the Wave 2 subcommittees began April 11.
From May 2017 to January 2018, ACR representatives also participated in Wave 1 subcommittees covering gastrointestinal, pulmonary, neuropsychiatric, peripheral vascular, cardiovascular and musculoskeletal disease management. The subcommittees produced eight new episode-based cost measures.
Ophthalmologic disease management was also included in Wave 1 but was excluded from future waves.
CMS assigned the subcommittees to define common episodes, determine episode triggers and recommend which services should be included in episode costs. The ACR anticipates the Wave 1 cost measures will appear in the upcoming proposed rule on the Quality Payment Program for 2019 implementation. More waves of episode-based, cost measure development are expected.
The ACR will endeavor to maintain a presence on every possible subcommittee to ensure medical imaging is fairly represented in the episodes and that physicians are not held accountable to costs for which they have no control. As with Wave 1, Wave 2 episode-based cost measures which will likely see field testing near the end of 2018.
For the cost performance category, CMS finalized a weight of 10 percent for the 2018 MIPS performance period. Practices are not required to submit data in this MIPS category because CMS will use claims data to determine cost allocation to physicians. CMS will use total cost per capita and Medicare spending per beneficiary this year.
MACRA legislation initially mandated weighting the cost performance category at 30 percent, but the recent Bipartisan Budget Act of 2018 gives CMS the flexibility to allocate between 10 percent and 30 percent to this category. In future years, episode-based cost measures will determine how Medicare allocates costs to physicians in the MIPS cost category.
For more information on MIPS cost categories, see “Radiologists May Now Be Accountable for Containing Medicare Costs and Spending Under MACRA,” by Andrew B. Rosenkrantz, MD, MPA, in the October 2017 Journal of the American College of Radiology.