MACRA’s Chosen One: PCMH (and PCSP, too)

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If you’ve been keeping up with our blog, you know that NCQA has a special interest in MACRA. Each week, we pinpoint a topic outlined in CMS’ final proposed rule for MACRA’s new payment system.

This week we talk about practices that should perform well on quality measures and that make the cut for quality bonuses—practices with PCMH and PCSP recognition. These practices are given some of the extra support[1] they need within MACRA.healthcare, medical and technology concept - group of doctors lo

Why does CMS put its faith in the medical home delivery model? Because it works. Practices transform through a recognition program that can make primary and specialty care into what patients want it to be.

MACRA requires “PCMH and PCSP recognition from a widely used, third-party program that is national in scope.” Practices that have earned recognition receive automatic full credit in the Merit-Based Incentive Payment System (MIPS) Clinical Practice Improvement Activities (CPIA) category. Automatic credit for CPIA makes up 15% of the MIPS score that determines whether clinicians get bonuses or penalties. The MIPS categories give the medical home model more of the attention it deserves.

More Than Automatic Credit

NCQA PCMH and PCSP are the leading recognition programs. Recognized practices are not only eligible to earn autocredit, they are positioned to do well in other MIPS categories of clinical quality, resource use and health IT. That’s because PCMHs and PCSPs have already been focusing on these top priorities to earn NCQA Recognition.

MACRA will further the spread of value-based care, which means great things for patients across the country. Did we mention we’re excited about that?

[1]To discover available support in your area, consult NCQA’s newly released Resource Directory.

Amy Maciejowski
Amy Maciejowski is the Communications Specialist at NCQA. She supports internal and external communications for NCQA, aiming to increase NCQA’s consumer facing brand. She creates blog posts, social media strategies and infographics to bring awareness to the health care quality agenda. Amy holds a master’s degree in Political Communications from American University.

14 thoughts on “MACRA’s Chosen One: PCMH (and PCSP, too)

  1. I am a pediatrician in private practice in North Carolina. Does the MIPS program apply to practices who bill only Medicaid, not Medicare? We are a PCMH-recognized practice.

    1. Dr. Medina, thank you for your question and your commitment to quality through NCQA PCMH! MIPS will not apply to any Medicaid payments – the new system applies exclusively to Medicare fee-for-service payments.

  2. At this time, PCMH recognition will only get you credit on the MIPS side of the MACRA payment scheme. NCQA PCMH itself currently will not qualify you as an APM, though we have asked CMS to issue specific guidance and a pathway for our PCMH practices to get that APM credit. We expect a final ruling later this fall.

    Thank you for your comment!

  3. Does it matter as to what level of PCSP recognition is achieved in relation to the automatic full credit for MIPS? For example, the brochure references recognition levels of 1, 2 and 3 being available for PCSP.

    1. Hi DeAnn- No, the recognition level does not matter. A practice must simply be recognized to achieve full CPIA credit under MIPS. Thanks so much for your comment! Let us know if you have any further questions.

  4. Will this soon be extended to NCQA’s PCCC recognized practices as well as it has for PCMH and PCSP?

  5. Late to the party here, but what do we know about CPIA credit for large multi-site practices? For instance, we have 30 practice sites with a 2:1 ratio of primary care to specialty care, and most (but not all) of our practices are recognized as PCMHs/PCSPs or are applying currently. What about the practices which do not have recognition? How does that play into our CPIA credit under MIPS if we are reporting as a group?

    Thanks.

    1. Hi Jess- So, the CPIA credit is not contingent on practice size. If a clinician is in a recognized practice by Oct. 1 they will get the full CPIA credit regardless of the practice size. Clinicians in practices that do not have recognition need to report on individual CPIA activities to earn the CPIA credit.

  6. What about a TIN (reporting as a group) that constitutes both PCP’s and specialists with the PCP practices recognized as PCMH. Would the group as a whole be able to get the 15 % credit because of that recognition?

    Thank you,

    1. Hi Khalid:
      I apologize for the late reply. Here is some language directly from CMS:

      As long as there is one practice within the TIN that is recognized as a certified patient-centered medical home or comparable specialty practice, the whole TIN will get the higher score for this performance category.

      I hope you find this information helpful. For up-to-date information and resources, please visit qpp.cms.gov and subscribe to our Quality Payment Program listserv.

      Thanks for reading!

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