Payment & CMS Policy


List of PCP Quality Measures for 2018


For 2018, reporting through the Quality Payment Program (QPP) starts with the selection of measures for the year. CMS has a set of 30 Primary Care Measures and you will select six of the 30 for the reporting year 2018. Select measures that are pertinent to the Medicare base of your practice. Also, consider measures that you can improve on during the year.

Need help? Contact MIPSPRO to set up a free live session with a MIPS expert, and let them know you are an ACOFP member.

Navigating MIPS in 2018 and Beyond
There are significant changes to MIPS from 2017 to 2018. Physicians and other eligible clinicians (ECs) will want to learn about these as soon as possible so that they can plan their measures for the year. This is the first year that Cost will be part of the MIPS Composite Score and will affect your payment adjustment. Learn about the four areas of reporting for MIPS.

This webinar is brought to you by Healthmonix and MIPSPRO. Sign up with MIPSPRO to monitor your measures quarterly and report at the end of the year.

Physician Fee Schedule Changes for 2018 – Summary
This document contains the top seven changes to the 2018 Physician Fee Schedule. Links to key documents are included for further detail. Some of the news is good, like the expansion of telehealth payments, especially for rural providers. A new and much needed program for those with prediabetes started April 1, 2018 – the CMS Diabetes Prevention Program (DPP). “Cost” is being phased into the Quality Payment Program (QPP) and is worth 10% of your total score for 2018. Incentive payments for those with top scores in Quality, Cost, Advancing Care Information and Practice Improvement Activities will start at 5% and go up to a high of 10%. For not reporting, or for lower total scores, there is a penalty of up to negative 5%, which is taken off your Medicare payments. 

Medicare Diabetes Prevention Program - New Payment Model
Diabetes impacts more than 25 percent of Americans age 65 or older. Diabetes is expected to increase two-fold for all adults in the US aged 18-79 if current trends continue. CMS tested and launched a Diabetes Prevention Program (DPP) on January 1, 2018. The prevention program targets those with prediabetes using a health behavior change methodology. Physicians are awarded payment bonuses, in addition to payment for HCPCS G-codes, based on patient success of weight loss combined with number of educational meetings attended. View the CMS Fact Sheet for more information.

ACOFP Comment Letter to CMS on New Payment Models
This letter from ACOFP to Seema Verma, Administrator for CMS, describes the top priorities for any new payment models proposed by CMS. 

2018 Chronic Care Management (CCM) Toolkit & Teaching Materials from CMS: 
Chronic care management (CCM) is a critical component of primary care that contributes to better outcomes and higher satisfaction for patients. On January 1, 2017, CMS established separate payment under billing codes for the additional time and resources physicians spend to provide appointment and between-appointment help that many Medicare and dual-eligible (Medicare and Medicaid) patients need to stay on track with their treatments and plan for better health. CCM payments can be made for services furnished to patients with two or more chronic conditions who are at significant risk of death, acute exacerbation/decompensation or functional decline. CMS data shows that two thirds of people on Medicare have two or more chronic conditions, which means many of your patients may benefit from a CCM program, including the help provided between visits. This toolkit includes information for health care professionals, including tips for getting started, fact sheets on the requirements for implementing a CCM program and educational materials to share with patients.

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Family Medicine to Have More Support for Identifying & Treating Mental Health

Mental disorders top the list of the most costly conditions in the US, accounting for $201 billion in health care spending in 2013, far more than was spent on heart disease or cancer, according to federal data. An estimated 8.1 million adults have schizophrenia or bipolar disorder, and 3.9 million go untreated in any given year, according to data from the National Institute for Mental Health.

The Helping Families in Mental Health Crisis Act 2016 steps up the requirement for insurers to cover mental health care on the same level as physical health. Additional support for screenings, programs to provide early intervention for children and initiatives to prevent suicide are included in the Act.