Article provided by: PA Clinical Network

quality based payments PA

PA Clinical Network invites you to explore quality-based payments in PA and how they can affect your private medical practice. Never has the delivery of quality and value to the patient been as important as it is now, and never has joining the PA Clinical Network made more sense! Patient satisfaction and several measures of quality can lead to bonus payments from your health insurance plans, and being with the right network can make all the difference.

PA Clinical Network provides quality-based payments management resources and smart risk management strategies, among many other benefits and services to our partners.

What is the Quality-Based Payment Program?

The Quality-Based Payment Program is a program that was approved by the Medicare Access and Chip Reauthorization Act (MACRA), which passed in 2015. MACRA is the law that authorized the Quality-Based payment program, which allows clinicians to choose how they want to participate based on their practice size, specialty, and patient or patient population under the two tracks:

1. Merit-based Incentive Payment System (Mips)

Offers a potential performance-based adjustment for clinicians who participate in Medicare (MIPS).

2. Alternative Payment Models (APMs)

Earn a Medicare incentive payment if you participate in an innovative payment model.

Part of the Quality-Based Payment Program includes a few elements that are critical for success. These include the following:

1. Improving patient outcomes
2. High-quality patient-centered care
3. Meaningful feedback to improve performance

The program will continue to evolve over time, and we will see continuous improvement, having a partner like PA Clinical Network can help immensely with the planning, implementation, and management of quality-based payments in PA.

Additionally, there are some strategic goals as follows that are part of the quality-based payment program. These build on the cornerstones that we just touched on:

  1. Improve beneficiary outcomes
  2. Enhance clinician experience
  3. Improving data and information sharing
  4. Maximize participation

PA Clinical Network helps to ensure operational excellence in program implementation.

What are the Paths of Participation?

Under MIPS, a smooth transition was created to a new payment system that fosters exceptional patient care via three CMS legacy programs, including:

1. Physician Quality Reporting System (PQRS)
2. Value-Based Payment Modifier (VM)
3. Medicare Electronic Health Record (EHR)

MIPS adjusts patient payment based on four performance categories, which are similar to the three CMS legacy programs:

1. Quality
2. Costs
3. Promoting Interoperability
4. Improvement Activities

The second way to participate in the Quality Payment Program is via an advanced alternative payment model. Let's take a look at a snapshot of this path:

APMs are simply ways of paying for health care that fosters and incentivizes quality and value. To illustrate it clearly, MACRA and APMs include:

  • CMS innovation models
  • Medicare Shared Savings Program (MSSP)
  • Demonstrations under the Health Care Quality Demonstration program, and
  • Demonstrations required by federal law

To learn more bout quality-based payments in PA, or if you would like to learn how joining the PA Clinical Network can be an invaluable decision for your private practice, contact PA Clinical Network today.


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