Members of the American College of Radiology (ACR) are playing an important role in initial and repeat field testing of cost measures for Medicare’s Quality Payment Program.
Eleven new episode-based cost measures and two re-evaluated cost measures are undergoing field testing under the aegis of Acumen Physician Services, a practice management software developer. Episode-based measures represent Medicare payment for medical care provided to a patient during an episode of care and influence rewards and penalties for quality performance of physicians participating in the Merit-Based Incentive Payment System (MIPS).
The ACR successfully advocated for CMS to revise the methodology for these measures to more fairly assess the radiologist’s contribution to the cost of care. The College had a representative on each clinical subcommittee — including subcommittees co-chaired by Ezequiel Silva III, MD, FACR; Joshua Hirsch, MD, FACR; and David Seidenwurm, MD, FACR — that helped develop these new episode-based cost measures.
The Total Per Capita Cost (TPCC) measure and the Medicare Spending Per Beneficiary (MSPB) measure are being re-evaluated. MIPS stakeholders have suggested the TPCC measure should be refined to better identify its primary care relationship and to allow for multiple clinicians and clinician groups to be attributed for a patient’s primary care management. For the MSPB measure, revisions were recommended to ensure attributed clinicians are responsible for a patient’s care during an episode and to remove services not related to the underlying reason for the index admission.
The change in attribution methodology for MSPB, now based on evaluation and management (E&M) services, should be favorable to radiologists. It is important to note that these two re-evaluated cost measures are separate from claims measures now in use and in the QPP. The re-evaluated measures will not affect the clinician’s MIPS scores and/or payment adjustments for 2018.
To participate in field testing and contribute feedback, stakeholders may find draft measure specifications on their CMS Enterprise Portal account or on the CMS MACRA Feedback page.
Clinicians and clinician groups that have met the minimum number of cases (10 episodes for the 11 episode-based cost measures, 35 episodes for the MSPB measure and/or 20 beneficiaries for the TPCC measure) in 2017 will find a field test report in their Enterprise Identity Management (EIDM) account.
Clinicians who did not receive a field test report can find mock field reports on the CMS MACRA Feedback page. Radiology practices, particularly those providing multispecialty, faculty practice and interventional services, should review if any physicians under their Tax Identification Numbers (TINs) may be involved in any of the episode-based cost measures that could result in future cost attributions.
Stakeholders may participate in the field testing for these measures until October 31, 2018.