HHS Report: Quality Payment Program Needs More Technical Oversight

A new report by HHS’ Office of Inspector General gives CMS points for making significant efforts to implement the Quality Payment Program (QPP) but says challenges remain that could undermine the program’s success.

Without sufficient technical assistance, participating clinicians could struggle to succeed, while others may opt out of the program altogether, the report warns.

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CMS also needs to develop a comprehensive program integrity plan to guard against fraud and improper payments, according to OIG.

In terms of implementing QPP, CMS has focused heavily on clinician readiness and acceptance of the program. The report cites outreach efforts, eligibility information, subregulatory guidance and a service center to field questions.

While CMS has awarded some technical assistance contracts, the assistance has tended to be general in nature rather than specialized to address practice-specific needs, the report says. “Clinician feedback collected by CMS demonstrates widespread awareness of the QPP, but also uncertainty about eligibility, data submission, and other key elements of the program,” the report stated.

OIG’s concerns are not new. In a December 2016 report, the HHS watchdog urged CMS to quickly ramp up technical assistance programs to ensure providers’ success, noting effective IT systems are critical to data submission, MIPS scores and payment adjustments.

The new report seems to underscore what recent surveys have found: that many clinicians are still not ready for QPP, the program that implements MACRA. A recent American Medical Association and KPMG survey found fewer than one in four physicians said they felt prepared to meet QPP requirements. In another survey by Nuance Communications, 60% of hospital executives who claimed to understand QPP requirements underestimated or didn’t know what the financial ramifications might be.

CMS has taken some steps for program integrity, including oversight provisions for the MIPS track and the Advanced APM track in the 2017 QPP final rule and creating an oversight process for CMS-approved vendors, OIG stated.

However, the agency has yet to designate officers to lead various aspects of the program integrity effort, such as policy and IT development. It also still needs to develop and implement a comprehensive program integrity plan, the report stated. Such a plan should address potential vulnerabilities in the MIPS data submission system and the accuracy of MIPS data, especially the clinician self-attestation measures.