Quality Reporting and the Importance of Qualified Clinical Data Registries (QCDRs) in Maximizing Your Success

Accurate and successful reporting on quality metrics is an important determinant of Medicare payment under the new Quality Payment Program (QPP) in the Medicare Access and CHIP Reauthorization Act (MACRA). These resources are intended to provide a high level understanding of the quality programs and to show you how to maximize your quality reporting success.

Quality Reporting and the Importance of Qualified Clinical Data Registries (QCDRs) in Maximizing Your Success

Quality Payment Programs

Alternative Payment Models (APMs): MACRA shifts physician payment from relying solely on the payments made for each service to increasing or decreasing payment rates based on cost and quality metrics. There is a spectrum of models being tested in Medicare and by commercial payers, ranging from pay-for-performance to more comprehensive models referred to as Alternative Payment Models (APMs). The term “alternative payment model” is used as a synonym for “alternative payment arrangement” and refers to payment arrangements that go beyond fee-for-service billing. Such arrangements can range from those that adjust fee-for-service payments on meeting certain criteria, to those that have entirely different payment structures than billing for each individual service. MACRA also defines a new program category called Advanced APMs. To qualify as an Advanced APM, the APM requires 50% of participants to use 1) certified electronic health records (EHR) technology (CEHRT) in 2017, 2) must provide payments based on quality measures, and 3) must involve financial risk. Physicians meeting qualified participation levels in an Advanced APM are exempt from MIPS, receive a 5% annual bonus payment for 6 years, and will receive a higher fee schedule update for 2026 and beyond.

Merit-Based Incentive Payment System (MIPS): MACRA consolidates and replaces three existing reporting programs into MIPS: PQRS, Value-Based Payment Modifier (VM), and Meaningful Use. The Meaningful Use program was replaced by the Accessing Care Information category (ACI), PQRS was reconfigured as Quality, and the VM was renamed and modified as the Resource Use/Cost category. MIPS also adds a new category of Clinical Practice Improvement Activities (CPIA). Qualified Clinical Data Registries (QCDRs) are a key reporting option for satisfying the Quality and CPIA categories under MIPS.

Resources

Use the resources below to help your practice report under the new MIPS program in 2017.

All resources

This file contains all the resources listed below.

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(ZIP, 241 KB)

Module Completion

Quality Reporting via MIPS

  • Quality reporting in MACRA via MIPS

    An introductory guide to reporting via MIPS for MACRA

    Download

    PDF, 73 KB

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  • AMA Medicare Payment Reform website

    AMA Payment Model Evaluator

  • AMA Payment Model Evaluator

Additional Resources

  • Maximize success by employing a QCDR

    Examines the performance categories of MIPS and shows how participating in a QCDR can help physicians successfully report across these categories

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    PDF, 191 KB

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  • CMS MACRA and Quality Payment Program website

  • CMS Qualified Clinical Data Registries website

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