BPCI Advanced, CMS’ successor program to BPCI, comes with new payment and quality rules that can impact how physicians earn MACRA Quality Payment Program bonuses. In the latest installment of our Success in BPCI Advanced webinar series, Remedy Partners’ Chief Medical Officer, Win Whitcomb, MD, MHM, covers the interplay between BPCI Advanced and the new physician payment rules under the Quality Payment Program (QPP).
MACRA substantially changes how physicians are paid by Medicare
The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 made significant changes to how physicians and clinicians were to be paid by Medicare by eliminating the Sustainable Growth Rate (SGR) formula. Instead, Part B payments would be tied to provider performance. As implemented, Medicare refers to “MACRA for physicians” as the Quality Payment Program.
BPCI Advanced qualifies as an Advanced Alternative Payment Model in QPP
There are two payment tracks in the QPP, the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM). Physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists are all subject to the QPP.
MIPS focuses on four core domains to improve care and financial performance: (1) Quality, (2) Resource Use (Cost), (3) Improvement Activities and (4) Advancing Care Information. There is a subcategory known as MIPS APM for providers participating in an APM that do not meet specific revenue or patient thresholds for Advanced APMs. It is expected that most providers will initially fall under MIPS as they will not meet APM participation thresholds in the first years of QPP.
APMs are a payment approach that rewards providers for delivering high quality, cost-efficient care. Advanced APMs are a subset of APMs that let practices earn more financial rewards in exchange for taking on risk related to patient outcomes.
BPCI Advanced qualifies as an Advanced APM and affords hospital-based physicians (hospitalists and hospital-based specialists) the opportunity to participate in an Advanced APM, providing new revenue opportunities and reduced reporting requirements under MIPS.
Advanced APMs protect against increasing penalties present in MIPS
MIPS and Advanced APMs have different impacts on physician fees. Under MIPS, physicians are exposed to potential penalties and incentives of -4 to +4 percent in the fee schedule in 2019 that scale up to -9 to +9 percent by 2022. The positive fee increases are subject to a multiplier to maintain cross-program budget neutrality.
Advanced APMs, however, are exempt from these penalties. In addition, Medicare includes an enticement of a one-time 5 percent lump sum bonus payment based on Part B Medicare activities during a performance year.
BPCI Advanced is a great way for physicians to meet steep APM thresholds
As mentioned earlier, there are specific patient and revenue thresholds providers must meet to quality as an Advanced APM. Specifically, in 2019, participants must have at least 50 percent of Medicare Part B payments or 35 percent of Medicare Part B patients in an Advanced APM. This grows to 75 percent of payments or 50 percent of patients by 2023.
While these thresholds seem ambitious, BPCI Advanced provides a great opportunity to achieve these benchmarks. Taking on large bundle sets in BPCI Advanced will allow physicians and clinicians to access larger patient pools to meet the Advanced APM minimums and reap its financial benefits. Even if physicians participating in BPCI Advanced do not meet the thresholds, they will have a decreased reporting burden than they would in the MIPS track of the QPP.
Remedy Partners has helped over 1,000 partners build, deploy and manage large scale bundled payment programs while achieving unprecedented financial and clinical outcomes. To learn more about your opportunities in BPCI Advanced and how we can help you materialize those improvements, click here and sign up for our upcoming Success in BPCI Advanced webinars.