American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Overview of Medicare Quality Programs

Starting in 2017, the Merit-based Incentive Payment (MIPS) System merges the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier (VM), and the EHR Incentive Program (EHR-MU);adds a new component called Improvement Activities; and combines these components into a single composite MIPS Final Score. For information on the MIPS program, please visit the ACS Quality Payment Program Resource Center.

The American College of Surgeons (ACS) Division of Advocacy and Health Policy has put together an interactive flowchart to help you successfully participate in the Medicare PQRS, the EHR-MU Incentive program, and the VM program. Failure to meet the requirements of these three mandatory programs in 2016 may result in a total penalty of up to 10 percent, which will be applied to physicians in 2018.

The ACS provides tools that can be used to comply with regulatory requirements such as PQRS, including the Surgeon Specific Registry (SSR) and the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) registry.

Notes

  • If noted as a required reporting program, you must participate in both programs.
  • You can choose from four reporting options.
  • Groups can choose to report via the group practice reporting option or the individual reporting option.

Click on the cells below for more information on key steps of the process.

Medicare Quality Programs Flowchart

Report nine measures across three National Quality Strategy domains for at least one Medicare patient Qualified Clinical Data Registry Electronic Health Records (EHR) Incentive Program Physician Quality Reporting System Report all measures included in web-interface and populate data fields for the first 248 consecutively ranked and assigned beneficiaries in the other in which they appear in the group’s sample for each module or preventive care measure for at least one Medicare patient Report nine measures across three National Quality Strategy domains for at least one Medicare patient Report nine measures including one cross cutting measure across three National Quality Strategy domains for at least 50 percent of your Medicare Part B patients Report nine measures including one cross cutting measure across three National Quality Strategy domains for at least 50 percent of your Medicare Part B patients Report on one measures group for at least 20 majority Medicare (11 Medicare) Part B patients Report nine measures including two outcomes measures across three National Quality Strategy domains for at least 50 percent of your patients (Medicare and Non-Medicare) Surgeon Specific Registry Metabolic and Bariatric Surgery Accreditation Quality Improvement Program Physician Quality Reporting System Electronic Health Records (EHR) Incentive Program Value-Based Payment Modifier Quality and Resource Use Reports