January 22, 2018

The Quality Payment Program (QPP) for 2018 is significantly different from last year’s program, primarily in terms of participation requirements.  Although 2018, like 2017, is also considered a transition year for the QPP, the Centers for Medicare and Medicaid Services (CMS) raised the low-volume threshold for participation for 2018 from $30,000 or less to $90,000 or less in Medicare Part B billings.

This means that many more anesthesiologists and nurse anesthetists would not receive a negative payment adjustment in 2020 if they did not participate in the QPP.  Still, there are some compelling reasons to continue participating in this cornerstone of the transition to value-based care mandated by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 and to continue reporting quality data through an anesthesia Qualified Clinical Data Registry (QCDR).

First, continued participation in the QPP supports the quality efforts of your hospitals, ambulatory surgery centers and other facilities, which, in turn, reflects well on you and your practice.

Second, a growing number of insurance payers are now including this information in their incentive programs and showing increased interest in providers who are participating in the QPP and reporting through a QCDR.  More private payers are starting to collect these quality measures to evaluate agreements with providers.

Third, CMS definitely plans to ramp up the Physician Compare five-star rating system.  Quality data reported through a QCDR will be one of the primary sources of information that CMS uses to determine the star ratings for anesthesia providers.  The visibility, usability and accessibility of these ratings for patients, payers and providers is expected to escalate rapidly, so it is clearly in your best interest to continue to report.  Your star rating (either as an individual or as a group) on Physician Compare will mirror the quality data you submit. 

2018 Anesthesia Quality Measures

All QCDRs saw tremendous change in their quality measure approvals for 2018.  Almost all of the 2017 quality measures were rejected by CMS for 2018, because most of these measures are topped out. CMS continues to raise the bar for quality performance.  The ABC/MiraMed QCDR created new measures and collaborated with other anesthesia QCDRs through the American Society of Anesthesiologists QCDR Roundtable to ensure harmonization across reporting platforms.

Following is a chart of the 2018 anesthesia quality measures:

ABC Clients:  Details on the 2018 QPP and the ABC/MiraMed QCDR were sent to you via email last week.  If you have any questions, your account executive will be glad to assist you.  In addition, ABC will be hosting a Q&A session for clients (which will be recorded) on 2017 and 2018 QCDR reporting on January 30, 2018 at 4:00 pm EST.  Please notify your account executive if you would like to attend this session.

With best wishes,

Tony Mira
President and CEO