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Anesthesia Quality Reporting: Understanding MIPS vs APM

Anesthesia quality reporting has been a hot topic over the last few years. While there was a period of time when experts and publications were convinced that every anesthesiologist group would need to adopt it – that view has since changed.

Many experts and practitioners feel that the metrics and methodology adopted by CMS and other agencies for quality reporting has been flawed. As a result, many anesthesiologists are doubtful of the utility of these reporting measures and how much they can encourage clinical improvement. Furthermore, the financial incentives have been watered down to the point that only anesthesiologists who rely on an unusually high percentage of their income from Medicare really need to adopt quality reporting for financial reasons.

It’s important to understand the base programs of anesthesia quality reporting to determine if it is right for your practice.

To help you make an informed decision let’s compare the programs that are talked about most: MIPS vs APM.

MIPS vs APM

When discussing anesthesia quality reporting MIPS and APM are the main programs addressed. Here’s a quick overview of what they are:

  • Merit-based Incentive Payment System (MIPS): CMS combined three legacy programs into this single system for reporting on quality, cost, improvement activities, and the promotion of interoperability.
  • Alternative Payment Model (APM): These are payment systems that provide added incentives to clinicians to provide high-quality and cost-efficient care.

Special Note Regarding APMs

Anesthesiologists must participate in advanced APMs to avoid penalties if they substitute APMs over MIPS. Advanced APMs are simply a subset of APMs that require the use of EHRs, requires quality measures comparable to MIPS measurements, and requires that either the participants bear significant risk, or the program be based on a medical home model.

Anesthesiologists must participate in advanced APMs to avoid penalties.

A Couple More Acronyms: EHR and PQRS

There are two more anesthesia quality reporting programs that come into play when discussing MIPS:

  • Medicare EHR Incentive Program (EHR) for eligible professionals: A payment incentive program for certain eligible professionals and hospitals. It requires these entities to demonstrate the adoption, implementation, meaningful use, and continual upgrades of certified EHR systems and technology.
  • Physician Quality Reporting System (PQRS): This program that utilizes financial incentives to encourage specific eligible professionals and groups to report on the quality of patient care.

How the Alphabet Soup Works Together

These three legacy programs (APM, EHR, and PQRS) come together under the umbrella of MIPS to generate a single score for your practice. This MIPS score determines the bonuses you can receive on your Medicare Part B payments. Visually it looks something like this:

Anesthesia Quality Reporting: Should You Do It?

Understanding the basic programs included in anesthesia quality reporting can help you determine if it is the right solution for your practice. There are a lot of other factors to think about like how much Medicare work you are doing and what your contracts look like. For a more comprehensive overview of anesthesia quality reporting and everything you should consider, download our eBook What’s the Rush? Anesthesia Quality Reporting.

Or if you want to discuss how to choose which program you should participate in or how to implement a quality measurement contact us or give us a call at (262)787-4050.

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