Quality reporting

Supporting Fair APM Payments: AMA Backs Accounting for Social Determinants of Health - 01/02/2020

Alternative payment models (APMs) are considered a key part of the future of value-based care. But for them to be successful, the American Medical Association says, APMs need to be fair, which means adjusting for the circumstances that make physicians’ cost and care challenges unique.

An Unfair Game: Quality Payment Program Rules Still Stacked Against Physicians - 01/02/2020

What the Quality Payment Program (QPP) lacks in simplicity, it makes up for in deck-stacking. After three years of physician participation, Medicare’s quality program to drive value-based care continues to generate confusion, frustration, and worry that it’s only going to swallow up more physicians in its complex and financially punitive gameplay.

Out of Physicians' Hands: TMA Challenges Unfair Quality Measures on Medication Adherence - 12/04/2019

Only patients can pick up their own prescriptions, and only patients can propel that medication into their own bodies. Physicians can educate, emphasize, and admonish – but at the end of the day, they can’t restrain and “pill” a squirming, uncooperative patient like a dog or cat. It’s up to patients to do the right thing for themselves. Yet, some health plans’ quality programs are putting that onus on physicians – through medication adherence metrics that determine whether physicians and accountable care organizations (ACOs) in value-based contracts receive bonus payments.

More Pain for Small Shops? 2020 Quality Program Rule Could Mean More Penalties - 10/01/2019

Small and solo practices already take the worst of the administrative and financial pounding the Quality Payment Program (QPP) dishes out each year. In the Texas Medical Association’s analysis, the government’s plans for the QPP in 2020 would make the situation even harder on those smaller shops. Since QPP’s birth in 2017, small practices have struggled with the demands and synapse-straining complexities of the program’s Merit-Based Incentive Payment System (MIPS). And TMA analysis shows the payment penalties those “have-not” practices incur fund the bonus payments earned by MIPS “haves” – often, larger practices with the resources to make the program work. Under the 2020 changes that the Centers for Medicare & Medicaid Services (CMS) has proposed, the maximum penalties for practices who don’t hit their MIPS targets will be larger than ever. But TMA’s review shows that MIPS – despite CMS’ claims to the contrary – isn’t getting any simpler.

File Your MIPS Targeted Review Request by Sept. 30 - 09/18/2019

Physicians have two weeks to file a targeted review request to appeal errors in their 2018 Merit-Based Incentive Payment System (MIPS) performance feedback and 2020 Medicare payment adjustment under the Quality Payment Program (QPP).

Anybody There? Physicians Unfairly Penalized for AWOL Medicare Advantage Patients - 09/04/2019

You’ve tried and tried and tried. Phone calls, emails – nothing. A Medicare Advantage plan assigned you a patient who didn’t choose you, and the patient is driving that point home – by ignoring you. Or maybe the contact information the plan gave you is out of date, and the patient’s latest phone number or email is unknown. Either way, your as-yet-unseen patient is AWOL – and you can be penalized for it on health plans’ quality ratings, which ultimately can affect payments. New Texas Medical Association policy takes aim at the unfairness this lack of patient response can present for physicians, while opening up an opportunity for medicine to work with health plans to solve the problem.

Unfair Playing Field? QPP Scoring May Hurt Physicians Not Hospital-Affiliated - 08/02/2019

As 2019 rolls on and physicians operate under new portions of the Merit-Based Incentive Payment System (MIPS), many physicians may face an even bigger disadvantage — simply by virtue of not billing the vast majority of their services at a hospital.

Physicians Concerned Over State’s Inaccurate Death Reporting - 06/25/2019

Some Texas physicians are concerned that the state’s death statistics are not as accurate as they should be. Like in many states, Texas’ death reporting system feeds inconsistent information into the state’s vital statistics database. As a result, distorted death statistics inaccurately portray how people are dying, which could have negative public health implications.

Faulty Guidelines - 06/03/2019

Former Texas Medical Association President Josie Williams, MD, was tenacious in advocating that organized medicine pay zealous attention to two topics: data and guidelines. In this, she was both sage and prescient. We have done well in following her recommendations on data, but we continue to fall far short of where we need to be on guidelines.

Get Awarded For Your Quality Work in 2018 - 05/23/2019

Did you submit Merit-Based Incentive Payment System data for the 2018 Quality Payment Program and feel like you deserve some kind of recognition for your hard work all year long? Apply now for the 2018-19 Physician Practice Quality Improvement Award.

Medicine to CMS: Medicare Report Inflates Success of Quality Program - 05/01/2019

If you read the recent Centers for Medicare & Medicaid Services (CMS) report on the first-year of the Quality Payment Program, you’d likely come away with the perception that the program’s launch was an overwhelming success. But a closer look by the Texas Medical Association raises serious doubts about CMS’ numbers, transparency, and cheerleading – so much so that TMA and seven other state medical associations are asking the agency to take back the report.

The Results Are In: Physicians Finally See How They Fared in First Year of MIPS - 10/16/2018

Physicians finally see how they fared in the first year of Medicare's "MIPS" quality payment program.

Revved-up Reporting - 05/03/2018

As federal quality reporting mandates and noncompliance penalties add up, experts say registries can help take the sting out of the process and rev up quality improvement for physician practices. The online reporting tool is also taking a front seat over claims-based reporting as Medicare signals its plans to eventually phase out that less efficient and less clinically accurate option.

New TMF Network Aims to Improve Adult Immunization Rates - 04/25/2018

Despite the availability of effective vaccines to help prevent influenza, pneumonia, and shingles, immunization rates for adults remain significantly low. To help boost these numbers for Medicare beneficiaries, the TMF Quality Innovation Network Quality Improvement Organization has established the Immunizations Network for physicians and other health care professionals.

And the Award for Practice Quality Improvement Goes to … - 04/20/2018

Almost 100 medical practices in Texas earned a TMF Physician Practice Quality Improvement Award in 2017

Tell the Feds About MIPS Burdens, Prevent a 2020 Penalty - 04/20/2018

Do you find collecting and reporting Medicare quality data to be challenging, time-consuming, costly, or meaningless? If so, here’s your chance to tell the feds about that burden.

The Value Modifier Program: Improve Performance, Payment - 04/19/2018

As the Centers for Medicare & Medicaid Services continues to refine and expand the physician value-based payment modifier program, physicians and health care providers must understand and stay current with the new methodology in order to achieve performance goals for better payment. The value modifier combines Physician Quality Reporting System (PQRS) quality measures, cost measures, and a payment adjustment for physicians.

Too Many Babies by C-Section? - 04/19/2018

Texas Medical Association’s Texas Medicine magazine, the association’s official publication now completely accessible to reporters, covers several important topics this month.

TMA Wins MIPS Exemption for Many Harvey-Affected Practices - 02/20/2018

Many physicians whose practices are located in areas affected by Hurricane Harvey will not be required to participate in the 2017 Merit-Based Incentive Payment System (MIPS) and will not face a 4-percent Medicare payment penalty in 2019, officials announced in December.

Very Few U.S. Physicians to See Medicare Bonuses This Year - 01/19/2018

Barely 20,000 clinicians nationwide will get Medicare bonuses this year from the Value-Based Payment Modifier program. Meanwhile, 296,475 clinicians will have their payments cut 1-2 percent, and more than 800,000 will see no change.

Take Action Now to Avoid 2019 Medicare Payment Penalty - 01/04/2018

Wouldn’t it be great if focusing on what you did in 2017 could affect how much you get paid in 2019? Well, good news, my time-constrained friend: That’s exactly how Medicare’s Quality Payment Program (QPP) works. All you have to do is submit your 2017 data to the Centers for Medicare & Medicaid Services (CMS) by March 31 to avoid a 4-percent Medicare payment penalty in 2019.

Are You Receiving MIPS Credit for Your Quality Data on Claims? - 08/14/2017

TMA recently received a call from a physician who was not receiving credit for the quality-data codes (QDCs) that her electronic health record (EHR) vendor was submitting through claims. She had been reporting QDCs via claims for her quality measures for months, but her EHR vendor had not been adding the 1-cent line-item charge that ensures the QDC line isn't dropped when the claim is processed. 

TMF Provides MACRA Support for Small Practices - 07/17/2017

The TMF Health Quality Institute, the physician-led nonprofit health care consulting company in Austin, has been contracted by the Centers for Medicare & Medicaid Services to help solo practices or those with 15 or few clinicians prepare for and participate in Medicare's new Quality Payment Program.

Get Awarded for Quality Improvements - 06/01/2017

Has your practice made a successful shift to quality reporting? Are you using health information technology to enhance patient engagement and preventative care? If so, get the recognition your practice deserves.

MIPS-Exempt? Check Online - 05/15/2017

Physicians can now go online to determine whether they are exempt from the Merit-Based Incentive Payment System (MIPS) for the 2017 performance period. Remember, your 2017 MIPS scores can affect your 2019 Medicare payments.