This year has been an important transitional period for oncology providers to start collecting their performance data to meet the requirements of the Quality Payment Program outlined in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The Quality Payment Program is a pay-for-performance system that emphasizes value-based, not quantity-incentivizing, care. MACRA replaces the sustainable growth rate formula as a mechanism for determining how the Centers for Medicare & Medicaid Services (CMS) reimburses physicians for their services and requires physicians to participate in one of two payment tracks: the Merit-Based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).
Although the full requirements of MACRA do not take effect until January 1, 2019, payment adjustments made in 2019 will be evaluated and paid based on performance data collected between January 1 and December 31, 2017. Practices that have not reported any data to CMS in 2017 will face a 4% Medicare reimbursement penalty in 2019 and additional penalties in 2020 if they haven’t complied with the full reporting requirements in 2018. For complete details contained in the MACRA legislation, visit the CMS Quality Payment Program website at https://qpp.cms.gov.
Since the passage of MACRA, ASCO has developed several initiatives to help oncologists transition to the value-based reimbursement system, including the Quality Oncology Practice Initiative (QOPI®) Qualified Clinical Data Registry (QCDR) for MIPS reporting; the Patient-Centered Oncology Payment Program; ASCO COME HOME; the Quality Training Program; and a free concierge service called the Practice Engagement Program.
The ASCO Post talked with Stephen S. Grubbs, MD, FASCO, Vice President of ASCO’s Clinical Affairs Department, about these new initiatives, discussing how they can aid oncologists to meet the sweeping changes underway in physician reimbursement and provide value-based care for their patients.
Improving Oncology Care
Please talk about some of the changes to QOPI and their impact on oncology practices as they transition to MACRA.
Two years ago, the QOPI QCDR became operational for the Physician Quality Reporting System (PQRS) reporting to CMS. The QOPI QCDR is now operational for MIPS reporting in 2017. The QCDR has been redesigned in 2017 for MIPS reporting and renamed the QOPI Reporting Registry.
This past July, practices participating in the QOPI Reporting Registry were able to meet their MIPS quality requirements reporting through their electronic health record by electronic capture of 1 or more of the 16 measures available in the registry, although only 1 measure is required to avoid the 2019 penalty.
These initiatives enable ASCO to provide our members with the tools and resources they need to provide the highest‑quality cancer care to patients while reducing health‑care costs.— Stephen S. Grubbs, MD, FASCO
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We designed the QOPI Reporting Registry to integrate the three performance categories physicians will need to report to CMS to fulfill MACRA requirements. They include quality of care, clinical practice improvement, and meaningful use of electronic health records, now called “Advancing Care Information.”
The QOPI Reporting Registry is capable of reporting all MIPS categories. In addition, the American Society for Radiation Oncology (ASTRO) has joined the QOPI Reporting Registry to offer this QCDR service to ASTRO members.
The QOPI certification program is rapidly expanding throughout the United States, as well as internationally, and there are several elements that make it important for MACRA compliance. Over 300 oncology practices have received QOPI certification, and elements of the certification will qualify for the Practice Improvement category of MIPS scoring. This is also true for participation in ASCO’s Quality Training Program.
In addition, in recognition of the quality measures practices have to adhere to under QOPI certification, a major medical liability insurance company is offering up to a 10% discount in its premium costs to practices that are QOPI-certified.
Adapting New Payment Models
How well are ASCO members adjusting to the changes in the payment systems in MACRA?
We are getting positive feedback on the reporting changes, and our members are adapting to the new system. The QOPI Reporting Registry makes it easy for practices to submit at least one measure this year to avoid a 4% Medicare reimbursement penalty in 2019. This is still a work in progress for ASCO and its members, but once all practices are in full compliance with MACRA reporting requirements, it will be a huge asset to the oncology community.
ASCO has also developed the Patient-Centered Oncology Payment (PCOP) payment model, and we are planning to submit the details of PCOP to MACRA’s Physician-Focused Payment Model Technical Advisory Committee by the end of this year for CMS consideration. This payment model is designed to reimburse oncologists for performing high-value care–improving activities that have not previously been compensated or were undercompensated—for example, patient management care that is performed during chemotherapy or immunotherapy treatment. PCOP offers oncologists the opportunity and framework to collaborate in an oncology-based alternative payment model.
Transitioning to Value-Based Care
How will the ASCO COME HOME initiative assist oncologists in transforming their practices to an alternative payment model?
ASCO COME HOME is an ASCO consulting service to assist practices in preparing for the transition from volume-based care delivery to value-based care delivery. This new ASCO service provides on-site consultation to evaluate a practice’s readiness for the transition and recommends potential practice changes to be successful in the new environment of MACRA and alternative payment models. Recommendations are based on oncology medical home concepts, and ASCO also has access to tools to assist in the transformation.
There is an initial consulting fee for what we are calling “readiness assessment” of oncology practice systems. (For more information about ASCO COME HOME, visit www.asco.org/practice-guidelines/practice-support/practice-support-services/asco-come-home.)
To improve patient satisfaction and clinical outcomes, ASCO developed the Quality Training Program. What does the program entail?
ASCO’s Quality Training Program is a 6-month, data-driven course in quality improvement for oncology providers who need to measure performance, investigate quality and safety issues, and implement change in their practices. Practices send a team of three or four individuals, including nonphysicians, to learn oncology-specific practice improvement skills. The teams meet for three sessions over the 6-month period and work on a practice improvement project between sessions. The course faculty members are experts in practice improvement, and practice teams are provided with a coach to assist in their project.
Quality Training Program activities currently qualify for MIPS Practice Improvement scoring, and there is a possibility that CMS will recognize participation in the program as an automatic fulfillment of the quality improvement requirement in MIPS for 2018. In 2018, we will have Quality Training Program sessions in Miami, from January to June, and at ASCO headquarters in Alexandria, Virginia, from July 2018 to January 2019. We are also developing a 1-day course we can take to cancer institutions around the country, to enable more oncologists to take advantage of the program. (For more information about ASCO’s Quality Training Program and to submit an application, visit www.asco.org/training-education/professional--development/quality-training-program.)
To personalize our interactions with community oncology practices, ASCO recently launched the Practice Engagement Program, a free concierge service to provide practices with a single point of contact to help them connect with ASCO’s tools, programs, and resources to overcome challenges and prepare for changes in CMS reimbursement payment models.
Collectively, these initiatives enable ASCO to provide our members with the tools and resources they need to provide the highest-quality cancer care to patients while reducing health-care costs. ■
DISCLOSURE: Dr. Grubbs reported no conflicts of interest.