The Quality Measure Crunch: How CMS Topped Out Scoring and Removal Policies Disproportionately Disadvantage Radiologists.

PURPOSE: CMS implemented Merit-Based Incentive Payment System (MIPS) policies to cap points and remove "topped out" quality measures having extremely high national performance. We assess such policies' impact on quality measure reporting, focusing on diagnostic radiology. METHODS: Data regarding MIPS 2019 quality measures were extracted from the CMS Quality Benchmarks File and the Quality Payment Program Explore Measures search tool and summarized by collection type and specialty. RESULTS: Among 348 MIPS measure-and-collection-type combinations, 40.5% were topped out (56.6% of those with a benchmark) and 23.3% were capped. Among measures with a benchmark, the percent topped out varied (P < .001) by collection type: claims 82.7%, qualified registry 60.4%, electronic health record 11.6%. The percent capped was also greatest for claims measures (52.3%). Among 699 Qualified Clinical Data Registry (QCDR) measures, 63 had a benchmark, of which 44.4% were topped out. The percent of measures topped out also varied significantly (P < .001) by specialty, ranging from 0.0% (electrophysiology) to 95.0% (diagnostic radiology). Among 20 unique measure-and-collection-type combinations for diagnostic radiology, only one was not topped out, and 30.0% were capped. Among 20 radiology QCDR measures, 5 had a benchmark, of which 3 were topped out. CONCLUSION: CMS topped out measure scoring and removal policies disproportionately impact radiology, which has the highest topped out percentage among all specialties and only a single non-topped out measure. This asymmetry disproportionately impairs radiologists' MIPS flexibility and is anticipated to progress in ensuing years. Current CMS policies create a looming crisis for radiologists in MIPS. The high risk of an insufficient number of available quality measures creates an urgent need for new radiology measure development.

Can state-supported interprofessional coalitions cure preceptor shortages?

The shortage of clinical preceptors compromises the current and future supply of healthcare providers and patient access to primary care. This article describes how an interprofessional coalition in South Carolina formed and sought government support to address the preceptor shortage. Some states have legislated preceptor tax credits and/or deductions to support the clinical education of future primary care healthcare providers. As a result of the coalition's work, a bill to establish similar incentives is pending in the South Carolina legislature.

MACRA, Alternative Payment Models, and the Physician-Focused Payment Model: Implications for Radiology.

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 describes alternative payment models (APMs) as new approaches to health care payment that incentivize higher quality and value. MACRA incentivizes increasing APM participation by all physician specialties over the coming years. Some APMs will be deemed Advanced APMs; clinicians who are a Qualifying Participant in an Advanced APM will receive substantial benefits under MACRA including an automatic 5% payment bonus, regardless of their performance and savings within the APM, and a larger payment rate increase beginning in 2026. Existing APMs are most relevant to primary care physicians, and opportunities for radiologists to participate in Advanced APMs fulfilling Qualified Participant requirements are limited. Physician-Focused Payment Models (PFPMs), as described in MACRA, are APMs that target physicians' Medicare payments based on quality and cost of physician services. PFPMs must address a new issue or specialty compared with existing APMs and will thus foster a more diverse range of APMs encompassing a wider range of specialties. The PFPM Technical Advisory Committee is a new independent agency that will review proposals for new PFPMs and provide recommendations to CMS regarding their approval. The PFPM Technical Advisory Committee comprises largely primary care physicians and health policy experts and is not required to consult clinical experts when reviewing new specialist-proposed PFPMs. As PFPMs provide a compelling opportunity for radiologists to demonstrate and be rewarded for their unique contributions toward patient care, radiologists should embrace this new model and actively partner with other stakeholders in developing radiology-relevant PFPMs.

A Look at MACRA: What to Expect in 2017.

The Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act of 2015 fundamentally changes how physicians who care for Medicare patients will be paid. Although physicians won't see changes in their payments in 2017, they need to understand that their performance in 2017 will be the basis for the payments made to them starting in 2019. This article summarizes the two paths for determining future Medicare payments established by the law: the merit-based incentive payment system and advanced alternative payment models.

Comanagement and Gainsharing Opportunities for Independent Physicians.

Gainsharing and comanagament programs are both successful means of achieving physician buy-in for all cost containment programs in Orthopaedic Trauma. Under comanagement agreements, physicians are reimbursed for their time and intellectual efforts in program and algorithm creation. The cost is minimal for the hospital in return for the millions of dollars in savings they achieve. Gainsharing models can incentivize physicians to quickly adopt cost-effective implant choices, care plans, and program development. Hospital systems keep the majority of the profits, patients, and insurance carriers benefit from the cost savings and physicians receive remuneration for their efforts. Careful attention must be paid to the legal issues surrounding the Federal Anti-Kickback Statute, the Civil Monetary Penalty Law, and the Physician Self-Referral Law when setting up these agreements. The keys to success for these programs are the presence of a physician champion, economic transparency for both physicians and hospitals, accurate data collection, and adequate economic incentive for physicians to drive change in practice patterns.