New opportunities for CQI value-based reimbursement: Find out how to become eligible

Blue Cross Blue Shield of Michigan’s Value Partnerships program is pleased to announce expanded opportunities for practitioners who participate in select Blue Cross Collaborative Quality Initiatives. We’ve expanded the number of eligible CQIs to 13 for the 2019 reimbursement period, which begins March 1, 2019. This list includes the five CQIs added for the 2018 reimbursement period, which began March 1, 2018, and one CQI added for the 2017 reimbursement period.

Earning CQI VBR means that eligible practitioners can receive reimbursement for participation in a CQI, in accordance with the Value-Based Reimbursement Fee Schedule. The VBR Fee Schedule sets fees at greater than 100 percent of the Standard Fee Schedule.

Measures and a population-based scoring method have been developed by CQI coordinating centers, in collaboration with consortium clinical leadership and Blue Cross. Each CQI uses a unique scoring method that best fits the nature of the collaborative.

Population-based performance is measured and scored using one of these approaches:

• Affiliated hospital or site — Physician performance is grouped by the collective average of the physicians at their primary hospital or site. Affiliation is determined by the coordinating center and consortium members.
• Affiliated physician organization — Physician performance is grouped by the collective average at the PO.
• Collaborative-wide — Physician performance is based on the collective average of all physicians.
• Regional — Physician performance is assessed at a regional level.
• Physician practice — Physician performance is based on the collective average at the physician practice.

Reimbursement period of March 1, 2018 to Feb. 28, 2019

Practitioners will be eligible to receive CQI VBR from March 1, 2018, through Feb. 28, 2019, if they’re enrolled in the Physician Group Incentive Program and participate in these CQIs:

• Anesthesiology Surgery Performance Improvement & Reporting Exchange Collaborative, also known as ASPIRE
• Blue Cross Blue Shield of Michigan Cardiovascular Consortium, also known as BMC2
• Michigan Anticoagulation Quality Improvement Initiative, also known as MAQI2
• Michigan Surgical Quality Collaborative, also known as MSQC
• Michigan Oncology Quality Consortium, also known as MOQC
• Michigan Urological Surgery Improvement Collaborative, also known as MUSIC

Reimbursement period of March 1, 2019 to Feb. 29, 2020

In addition to the above CQIs, practitioners will be eligible to receive CQI VBR from March 1, 2019, through Feb. 29, 2020, if they’re enrolled in the Physician Group Incentive Program and participate in these CQIs:

• Michigan Arthroplasty Registry Collaborative Quality Initiative, also known as MARCQI
• Michigan Bariatric Surgery Collaborative, also known as MBSC
• Michigan Emergency Department Improvement Collaborative, also known as MEDIC
• Michigan Radiation Oncology Quality Collaborative, also known as MROQC
• Michigan Surgical Quality Collaborative, also known as MSQC
• Michigan Spine Surgery Improvement Collaborative, also known as MSSIC
• Michigan Society of Thoracic and Cardiovascular Surgery Collaborative, also known as MSTCVS

Physicians who meet the CQI performance expectations will receive 103 percent of the Standard Fee Schedule for CQI VBR in addition to any specialist VBR opportunity available through PGIP.

Eligibility guidelines

As a reminder, for a physician to be eligible for CQI VBR, he or she must meet the performance targets set by the coordinating center, and these guidelines:

• The physician must be enrolled in Blue Cross’ PGIP program through an affiliated PGIP physician organization for at least one year.
• The physician must have contributed data to the CQI’s clinical data registry for at least two years, including at least one year’s worth of baseline data, to be considered eligible.

A physician organization nomination isn’t required for CQI VBR. Instead, the CQI coordinating center notifies Blue Cross about which physicians meet the appropriate performance targets. The PO will notify physicians who receive CQI VBR, as it does for other specialist VBR.

Physicians are limited to receiving 103 percent of the Standard Fee Schedule for CQI performance, even if they participate in more than one CQI. For example, if a physician participates in both the BMC2 and MSQC CQIs and the physician’s performance is such that he or she would be eligible for CQI VBR for both, the physician will receive 103 percent VBR.

Contact information for managers of CQI coordinating centers

Contact the appropriate CQI coordinating center manager listed in the table below for more information about these CQIs.

Click here to access a printable PDF with detailed information about the measures and scoring for the March 1, 2019, to Feb. 29, 2020, reimbursement period.