CMS releases 2019 proposed rule for Quality Payment Program

The Centers for Medicare & Medicaid Services (CMS) released its proposed rule for the 2019 Quality Payment Program (QPP). The QPP proposed rule affects the 2019 performance period/2021 payment year for practices participating in the Merit-based Incentive Payment System (MIPS) and the Alternative Payment Models (APMs), as established within the Medicare Access and CHIP Reauthorization Act (MACRA).  

CMS has proposed several changes to MIPS in the 2019 proposed rule, including:  

  • Another threshold criteria – related to covered professional services. To be excluded from MIPS, eligible clinicians (ECs) or groups would need to meet one of the following three criterion: have less than $90,000 in Part B allowed charges for covered professional services, or provide care to less than 200 beneficiaries, or provide less than 200 covered professional services under the Medicare Physician Fee Schedule.  
  • In addition, ECs or groups would be able to opt-in to MIPS if they meet or exceed one or two, but not all, of the low-volume threshold criterion. 
  • The proposed performance threshold for 2019 is 30 MIPS Total Points. ECs or practices who fail to participate, when required, or to meet the 30-point threshold may incur up to a negative 7% payment adjustment in 2021. 

CMS has created a fact sheet comparing the current QPP rule with the proposed rule for the upcoming year. The comment period for the proposed rule will close on September 10. ASA staff is reviewing the proposed regulations in detail and share additional information as available.

Internal improvement measures released

AQI recently released Internal Improvement Measures for reporting to the National Anesthesia Clinical Outcomes Registry (NACOR). The collection of 12 measures is intended for internal improvement purposes only and are optional for practices to report.

Reporting these measures may aid a practice with the following:

  • Benchmark their performance against other anesthesia practices
  • Demonstrate their value and quality of care to payers and facility administrators
  • Assist with local practice and quality improvement initiatives

CMS has not recognized and will not accept these measures as part of an anesthesiologist's or practice's participation in the Merit-based Incentive Payment System (MIPS), or as part of an Advanced Alternative Payment Model (APM). AQI will not send data gathered on these measures to CMS.

CMS offers QPP Performance Feedback Video for Groups

Groups that participated in the Merit-based Incentive Payment System (MIPS) in 2017 can now access performance feedback. The CMS video, How to Access Performance Feedback for Groups provides a step-by-step guide to viewing details on MIPS group scores on the Quality Payment Program website.

CMS also has posted demonstration videos on How to Access Performance Feedback for Individuals for clinicians whose performances were scored separately from their groups.

Attend the pre-conference Quality Reporting Workshop at Anesthesia Quality Meeting

Learn how to have success at MACRA reporting in the future at AQI's upcoming pre-conference workshop "MACRA and Beyond - Successfully Reporting to NACOR" before the Anesthesia Quality Meeting. The optional pre-conference meeting is scheduled on Friday, November 16, at ASA headquarters in Schaumburg, Illinois.


Have a question about NACOR or AQI? Meet your partners in quality reporting at the AQI Booth in the ASA Resource Center at ANESTHESIOLOGY® 2018 in San Francisco. The AQI team will be at the booth October 13 - 16.


2018 MACRA MIPS Information

Register for 2018 NACOR quality reporting

2018 NACOR pricing

2018 NACOR Data Definitions

2018 QCDR Measure Booklet

2018 Recommended Improvement Activities

Office Hours FAQs

Question: What is the code for Quantum 31?

Quantum 31 is a licensed measure for MEDNAX and it has no AQI Measure ID. The denominator includes CPT procedure codes, not ASA codes. This measure should be reported by providers who actually place the central line, not by providers who provide anesthesia for central line placement. Since MEDNAX is the measure steward for Quantum 31, all questions should be directed to MEDNAX.

Question: Have measure specifications changed from 2017 to 2018?

Yes, the QCDR measure specifications have changed from 2017 to 2018. For more details, refer to the new 2018 QCRD Measure booklet.