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What are the incentive payment programs for the year 2011 other than PQRS, EHR & ERx?


Primary Care Incentive Payment Program (PCIP)

PPACA (Patient Protection and Affordable Care Act )
established the PCIP to provide incentive payments to qualified providers and practitioners for primary care services furnished between January 1, 2011 and January 1, 2016. CMS will provide a 10 percent incentive payment to primary care practitioners defined as:

1) a physician who has a primary specialty designation of family practice, internal medicine, geriatrics, or pediatrics; or

2) a nurse practitioner, clinical nurse specialist, or physician assistant.

Health Professional Shortage Area (HPSA) Bonus Payments

The HPSA bonus is a 10 percent incentive payment paid to physicians who provide covered professional services in a geographic HPSA. Medicare incentive payments are available only in geographic HPSAs.

HPSA Surgical Incentive Payment Program (HSIP)

PPACA also contains a provision to provide incentive payments to surgeons in designated Health Professional Shortage Areas (HPSA) for services furnished between January 1, 2011 and January 1, 2016. CMS will provide a 10 percent quarterly bonus payment to general surgeons for approximately 4,300 surgical procedures provided in a HPSA.

End Stage Renal Disease (ESRD) Quality Incentive Program (QIP)

The program will provide a financial incentive for ESRD providers/facilities to meet or exceed national performance standards on specified quality measures.

QIP MEASURES: The following are brief descriptions of the ESRD QIP measures and standards applying to facility performance that will determine reductions in PY 2012:

Anemia Management:

The intent is to control anemia and maintain optimum hemoglobin levels within the range of 10-12 g/dL (grams per deciliter).

Anemia management will be assessed by two separate measures:

1. CMS will assess the percentage of patients whose hemoglobin levels dipped under 10 g/dL. The program assigns this measure the greatest weight in facility performance calculation, because numbers under 10 g/dL are highly undesirable. (Weight = 50%)

2. CMS will assess the percentage of patients whose hemoglobin levels exceeded 12 g/dL. Numbers greater than 12 g/dL could suggest unnecessary or excessive administration of certain drugs. (Weight = 25%)

Hemodialysis Adequacy:

The intent is to ensure adequate removal of waste products in the blood. CMS will assess the percentage of patients who achieve a urea reduction ratio (URR) of 65% or greater at each facility. (Weight = 25%)

Methodology for (Payment Year) PY 2012: Facilities can earn a maximum of 10 points for each of the three measures, based on their performance on the established performance standard for each measure. The highest possible “Total Performance Score” any facility can earn is 30 points. CMS will subtract two points for each percentage point that the facility performs below the performance standard. CMS then will apply the weights to the measures and calculate the total weighted performance scores for each measure.

Finally, CMS will sum the resulting scores for each of the three weighted measures to arrive at the facility’s Total Performance Score.

A facility must have a minimum of 11 reportable cases to receive a score on each measure, and must receive a score on all three measures in order to receive a Total Performance Score. As indicated in the payment reduction scale below, facilities with a total performance score of 26 points or greater would not be subject to any payment reduction in PY 2012. The maximum payment reduction a facility could be subject to is 2.0 percent, which would apply only to facilities with a Total Performance Score of 10 points or lower.

If Total Facility Score is 26-30 points then the Payment reduction to Facility will be 0%

If Total Facility Score is 21-25 points then the Payment reduction to Facility will be 0.5%

If Total Facility Score is 16-20 points then the Payment reduction to Facility will be 1.0%

If Total Facility Score is 11-15 points then the Payment reduction to Facility will be 1.5%

If Total Facility Score is 0-10 points then the Payment reduction to Facility will be 2.0%

For more informations please see:

http://www.cms.gov/ESRDQualityImproveInit/01_overview.asp#TopOfPage

http://www.gpo.gov/fdsys/pkg/FR-2011-01-05/pdf/2010-33143.pdf



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