The healthcare system has changed the way it pays doctors and other medical professionals. Probably, the most significant change made within the healthcare provider payment framework in recent years is the Quality Payment Program. Such a new payment system is vital for doctors, medical staff, and healthcare managers to understand, as it changes how they will be paid and how well they perform will be assessed. However, most small to medium-sized clinics still wonder, what is QPP in healthcare?
As it will impact the way they are paid, the way their performance is graded, and how patient care is optimized in hospitals and practices.
The purpose of the QPP is to refocus healthcare from being volume-based to value-based. This means that instead of paying clinicians for treating as many patients as possible, the system reimburses them for the volume-based care provided. The primary discovery of what is QPP in MIPS healthcare payment model is a smoother path to rewarding the quality of care and patient outcomes.
How Does the QPP Work?
Upon understanding what is QPP in a healthcare payment model, one needs to look into the two main stages. They include:
The categories include quality reporting, promoting interoperability, improvement activities, and cost. Your score then determines how much of a bonus, a penalty, or no payment adjustment you receive at all.
Who Must Participate in QPP?
Knowing what is QPP in healthcare includes who must participate. Only clinicians who bill under Medicare Part B and meet several eligibility criteria must participate. These professionals include physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, among several others.
Most clinicians participate in the QPP program through MIPS value pathways. Unless you are part of a large hospital system or value-based care network, MIPS scores you as a provider each year on different performance categories.
For most providers, it is not a choice. If these eligible professionals do not submit the required data, they receive automatic cuts from Medicare.
Why is QPP Important for Healthcare Providers?
QPP is not only a reporting requirement but also a financial gatekeeper. If you ignore QPP, your payments from Medicare can be reduced. If you do well, you can get paid positive adjustment or even more bonuses. Therefore, more providers want to know what is QPP in healthcare and how they can fare better in it.
In summary, QPP largely impacts three key areas which are:
- Revenue
- Reputation
- Quality of care
Those who adequately plan their QPP strategy in advance and track their performance tend to benefit the most.
MIPS in QPP
MIPS is the foundation participation route when answering the question: what is QPP in healthcare?
To ensure no reporting mistakes and maximize performance to their score, many providers partner with a company. The healthcare is complicated, not understanding the documentation, tracking, and meeting deadlines leads to low scoring.
What Are MIPS MVP?
CMS introduced MVP to simplify reporting. MVPs allow the provider to report fewer measures, and it is specialty-based.
What Providers Struggle Within the QPP System
Even though it is aimed at improving healthcare, several providers are unable to comply fully. Some of the providers’ challenges include: change in program rules, inability to collect correct data, and meet technology and documentation requirements. The number of performance categories is yet another significant problem that some providers cannot manage.
This is the reason why many practices outsource reporting and performance tracking to experts.
How Prime Well Med Solutions Helps
After understand what is QPP in healthcare, the next best thing is compliance and performance. Prime Well Med Solutions helps clinicians navigate QPP reporting, improve their MIPS score, and keep up with the constantly changing CMS requirements. Instead of documentation, committing errors when submitting data, and getting penalized, the provider gets clear guidance and a comprehensive support system.
The question: what is QPP in healthcare? is no longer just a technical question. The question determines how long a healthcare practice will stay afloat in a value-based care system. QPP rewards the provider who opts to deliver quality care, rewards the use of certified technology, and has high reporting standards. The alternative is reduced Medicare revenue and high penalties.
Wrapping Up
No matter if you are a solo provider, medical group, billing team or administrator. Even if you know CAHPS and appreciate how it has improved patient experience in the past, comprehensive understanding of QPP and proactive advanced planning can safeguard both your performance and your payment.
If your practice requires help with reporting, compliance tracking, or performance strategy, experts have got you covered. Prime Well Med Solutions is with you.
