CPC+: CPC+ and Quality Payment Program Changes

June 8, 2018

Written by Kristen Schuster, Practice Facilitator

CPC+ practices continue to work hard to improve patient engagement, office workflow and care coordination. To help with these goals, here is a list of helpful changes in 2018.

Low Volume Exemption. These values increased significantly! To exceed the thresholds, you need to see at least 200 Medicare patients AND have billed at least $90,000 in allowable Medicare Part B charges.
Important note – the Balanced Budget Act of 2018 tweaked which Medicare Part B charges are used to determine the allowable charges. Effective as of 2018, CMS will use only Part B “service” charges rather than “items and services.”

If your volumes fall BELOW either the patient or the allowable charges threshold, you can choose to voluntarily participate, but will NOT be assess a negative penalty if you do NOT participate.
If your volumes EXCEED both the patient and the allowable charges threshold, you will be assessed a negative 5% payment adjustment if you do NOT participate. Check your Participation Status here- https://qpp.cms.gov/participation-lookup. In most cases, submitting as a group will allow your entire organization to benefit from your CPC+ involvement.
Neutral Score. The neutral point has increased to 15 points in 2018. As long your 2018 final score is 15 or greater, you will not receive a negative adjustment if exceed the exemption thresholds.
Cost Category. There is a lot of buzz about including the cost category for the 2018 MIPS reporting year. However, because CPC+ is an Alternative Payment Model, you are already being scored in the CPC+ model on cost. Therefore, your performance weights remain the same as 2017 with 50% in the Quality Category, 30% in Promoting Interoperability and 20% for Improvement Activities. This year, the Cost Category will account for up to 10 points of your final score. This category is calculated from patients attributed to you by CMS and you do not need to report any additional data.
Bonus Points.
1. Complex Patient Bonus. You can receive up to 5 bonus points for a higher than average Hierarchical Condition Category (HCC) scores. Quality category – quality reporting will cover the full year
2. Small Practice Bonus. If your practice has less than 15 providers, you will receive 5 bonus points.
3. High Priority Measures. You are required to submit one High Priority Measure. You will receive bonus points for each additional High Priority Measure submitted that meets the 20-case minimum and data completeness criteria. Within CPC+ your High Priority Measures are: Controlling High Blood Pressure, Diabetes: Hemoglobin A1c Poor Control, Falls: Screening for Future Fall Risk and Closing the Referral Loop, Inpatient Hospital Utilization, Emergency Department Utilization and CAHPS.
4. Quality Improvement Score. If you have submitted the same quality measure in 2017 and 2018 and you have improved your score, CMS will give you additional points based on your improvement up to 10 percentage points.

If you have questions or would like to have a one-on-one conversation with one of our QPP experts to help you design your 2018 action plan please contact Amber Rogers at arogers@mpqhf.org.

Please use the “Leave a Reply” section below, or email Kristen Schuster directly with your questions or comments.

Other Resource Links
CMS Implementation Guide
See all CPC+ Blog Posts

Subscribe to the HTS CPC+ Blog
Subscribe