In a new ASCO in Action Podcast, ASCO Vice President of Clinical Affairs Stephen Grubbs, MD, FASCO, joins ASCO CEO Dr. Clifford A. Hudis, FACP, FASCO, to break down the Quality Payment Program (QPP) and discuss the reimbursement changes coming to oncology practices in the United States.
Dr. Grubbs explains that the QPP is the government’s effort to transition healthcare reimbursement from a volume-based system to a value-based one. The Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Model (APM) are the two tracks under QPP moving physicians to a performance-based system. Here, physicians must show they are providing high-quality, efficient care based on evidence-based and practice-specific quality data to earn a positive payment adjustment.
This year, according to Dr. Grubbs, physicians need to report on a minimum of five or more quality metrics to avoid a negative payment adjustment in 2020. By 2019, he anticipates a “full-blown requirement.”
The MIPS system is considered a graduated scale in which penalties will increase each year, but the potential benefits could get higher as well. It is a system whereby physicians are evaluated relative to their peers. “It is revenue neutral,” says Dr. Grubbs. “The money that is taken away from those at the bottom of the scale will be given to those at the top of the scale. It’s a zero-sum game in terms of Medicare payments.”
The APM is the second track under QPP in which physicians are paid based on quality metrics and the level of risk that they take on.
For a practice to succeed in this new payment system, Dr. Grubbs says that practices must know how to implement and demonstrate practice improvements. Physicians must be “carefully monitoring quality metrics and make sure that they are improving over time,” he says. “I think that's the important thing that physicians are learning now is they have to report on quality and other parts of their practice that should show up as better care for the patient.”