AAPM (Advanced Alternative Payment Model): an APM that has met the statutory APM requirements, as well as three additional criteria: (1) the APM must require participants to use certified EHR technology, (2) the APM must provide payment for covered services based on quality measures comparable to those in the MIPS quality performance category, (3) APM entities must either bear risk for monetary losses of more than a nominal amount, or be a Medical Home Model expanded under section 1115A(c) of the Act. The primary care AAPMs for the 2017 performance period include:
- Comprehensive Primary Care Plus (CPC+)
- Medicare Shared Savings Program (MSSP) Tracks 2 and 3
- Next Generation Accountable Care Organization (ACO)
- The Vermont ACO Initiative (as part of the Vermont All-Payer ACO Model)
ACO (Accountable Care Organization): group of doctors, hospitals, and other health care providers, who come together voluntarily and agree to share responsibility for the quality, cost, and coordination of care with aligned incentives for a defined population of patients
ACP (Augusta Care Partners)
AHCA (American Health Care Act): congressional bill to repeal the Patient Protection and Affordable Care Act
AMG (Augusta Medical Group)
APM (Alternative Payment Model): payment approach that gives added incentive payments to provide high-quality and cost-efficient care; APMs can apply to a specific clinical condition, a care episode, or a population
AWV (Annual Wellness Visit): yearly appointment covered by Medicare to discuss a patient’s preventive care plan
CAHPS (Consumer Assessment of Healthcare Providers & Systems): patient surveys that rate healthcare experiences
CDC (Centers for Disease Control)
CEHRT (Certified EHR Technology): The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) have established standards and other criteria for structured data that electronic health records (EHRs) must use in order to report Advancing Care Information. Certified EHR technology (CEHRT) gives assurance to purchasers and other users that an EHR system or module offers the necessary technological capability, functionality, and security to help them meet the meaningful use criteria. Certification also assures clinicians and patients the electronic health IT products and systems they use are secure, can maintain data confidentially, and can work with other systems to share information.
CME (Continuing Medical Education)
CMS (Centers for Medicare & Medicaid Services)
COPD (Chronic Obstructive Pulmonary Disease)
CRC (Colorectal Cancer)
DSMT (Diabetes Self-Management Training): the process of facilitating
the knowledge, skill, and ability necessary for diabetes self-care.
ED (Emergency Department)
EHR (Electronic Health Record)
ESRD (End Stage Renal Disease):
FFS (Fee For Service): a method in which doctors and other health care providers are paid for each service performed. Examples of services include tests and office visits.
FIT DNA Test (Fecal Immunochemical DNA Test): a test that detects blood as well as abnormal sections of DNA in the stool
FOBT (Fecal Occult Blood Test): a test that detects blood in the stool
HCC (Hierarchical Condition Category): a payment model mandated by the Centers for Medicare and Medicaid Services (CMS) in 1997. Implemented in 2003, this model identifies individuals with serious or chronic illness and assigns a risk factor score to the person based upon a combination of the individual’s health conditions and demographic details. The individual’s health conditions are identified via International Classification of Diseases – 10 (ICD –10) diagnoses that are submitted by providers on incoming claims. There are more than 9000 ICD-10 codes that map to 79 HCC codes in the Risk Adjustment model.
HIPAA (Health Insurance Portability & Accountability Act): The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required the Secretary of the U.S. Department of Health and Human Services (HHS) to develop regulations protecting the privacy and security of certain health information.1 To fulfill this requirement, HHS published what are commonly known as the HIPAA Privacy Rule and the HIPAA Security Rule. The Privacy Rule, or Standards for Privacy of Individually Identifiable Health Information, establishes national standards for the protection of certain health information. The Security Standards for the Protection of Electronic Protected Health Information (the Security Rule) establish a national set of security standards for protecting certain health information that is held or transferred in electronic form. The Security Rule operationalizes the protections contained in the Privacy Rule by addressing the technical and non-technical safeguards that organizations called “covered entities” must put in place to secure individuals’ “electronic protected health information.”
HQEP (Hospital Quality & Efficiency Program): agreement between a hospital and a physician group used to improve quality and reduce costs in the hospital
MACRA (Medicare Access and CHIP Reauthorization Act): legislation that made changes to how Medicare pays physicians for care provided to traditional Medicare beneficiaries. These changes include: repealing the sustainable growth rate (SGR) formula for determining Medicare payments for health care clinicians’ services; creating a new framework for rewarding health care clinicians for giving better care; and combining existing quality reporting programs into one new system.
MIPS (Merit-based Incentive Payment System): one of two new payment tracks established by MACRA that combines aspects of the Physician Quality Reporting System (PQRS), the Value Modifier (VM or Value-based Payment Modifier), and the Medicare Electronic Health Record (EHR) Incentive Program (Meaningful Use). MIPS consolidates these Medicare initiatives into a single program based on: quality, cost, advancing care information (meaningful use), and adds a new category called improvement activities which is based on the medical home
MNT (Medical Nutrition Therapy): counseling provided by a registered dietitian nutritionist
MSSP (Medicare Shared Savings Program): Congress created the Medicare Shared Savings Program (MSSP) to facilitate coordination and cooperation among clinicians to improve the quality of care for Medicare fee-for-service (FFS) beneficiaries and reduce unnecessary costs. Eligible clinicians, hospitals, and suppliers may participate in the MSSP by creating or participating in an accountable care organization (ACO). The MSSP will reward ACOs that lower their growth in health care costs while meeting performance standards on quality of care and putting patients first. Participation in an ACO is purely voluntary. The Centers for Medicare & Medicaid Services (CMS) has designated MSSP Tracks 2 and 3 as Advanced Alternative Payment Models (AAPMs).
PCP (Primary Care Provider)
PHQ (Patient Health Questionnaire): screening and diagnostic tool for mental health disorders
PY (Performance Year): the year in which performance is being measured
QCDR (Qualified Clinical Data Registry): an entity that collects clinical data from MIPS clinicians (both individual and groups) and submits it to CMS on their behalf for purposes of MIPS.
QPP (Quality Payment Program): the umbrella term used to describe the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (AAPMs)
SIR (Standardized Infection Ratio): statistic used to track healthcare associated infections, comparing the actual number to the predicted number of infections
TIN (Taxpayer Identification Number)
UTI (Urinary Tract Infection)
AAFP. MACRAnyms: Acronyms and Terms Related to MACRA. Retrieved from http://www.aafp.org/practice-management/payment/medicare-payment/acronyms.html
American Cancer Society. (2017, July 7). Colorectal Cancer Screening Tests. https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/screening-tests-used.html
CT Department of Public Health. (2016, July 13). What is the SIR, and What Does it Mean? Retrieved from http://www.ct.gov/dph/cwp/view.asp?q=474100
CMS. Merit-Based Incentive Payment System (MIPS): 2017 CMS-Approved Qualified Clinical Data Registries (QCDRs). https://qpp.cms.gov/docs/QPP_2017_CMS_Approved_QCDRs.pdf
CMS. Fee For Service. https://www.healthcare.gov/glossary/fee-for-service/
Security Health Plan. Risk Adjustment and Hierarchical Condition Category Coding
The Diabetes Educator. (2015). Diabetes Self-management Education and Support in Type 2 Diabetes. https://www.diabeteseducator.org/docs/default-source/practice/practice-resources/position-statements/dsme_joint_position_statement_2015.pdf?sfvrsn=0
US Department of Health & Human Services. (2013, July 26). Summary of the HIPAA Security Rule. https://www.hhs.gov/hipaa/for-professionals/security/laws-regulations/index.html