Policy and Clinician Payment: Do You Know These Changes Affecting Your Pocketbook?

Gordon H. Sun, MD, MS


August 10, 2018

A Plethora of Quality Measures

In 2018, 275 quality measures are eligible for submission to MIPS, spanning a wide variety of conditions such as coronary artery disease, chronic obstructive pulmonary disease, depression, diabetes mellitus, heart failure, hepatitis C infection, rheumatoid arthritis, and sleep apnea, among others. MIPS participants must submit data for at least six measures for the 12-month performance period (January-December).[15]

Alternative Payment Models

Providers not participating in MIPS may join an APM, many of which are based on the concept of shared financial risk between the payer and the provider. Depending on the chosen risk model, participants may receive savings bonuses from the difference between actual and budgeted costs for care, be responsible for paying back all or some costs for care that surpasses a certain benchmark, or both. Benefits of participating in eligible APMs include certain APM-specific rewards and favorable MIPS scoring.

What Are the Requirements of an Advanced APM?


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