MIPS 2018 Updates for Healthcare Providers

Introduction to MIPS 2018

The MIPS 2018 initiative is designed to assist healthcare providers in realigning their practices to ensure compliance, thereby allowing them to continue benefiting from incentive payments. On November 2, 2017, the Centers for Medicare & Medicaid Services (CMS) provided an update regarding the MIPS 2018 changes relevant to the Quality Payment Program (QPP).

Background on MIPS 2018 Updates

The U.S. healthcare system is undergoing a significant transformation, emphasizing quality care. The MIPS 2018 updates represent a refinement of the QPP policies while considering advancements in infrastructure, technology, clinical practices, and support for physicians.

MIPS 2018 Objectives and Updates

Strategic Objectives of QPP

CMS has identified seven strategic objectives for the QPP through the MIPS 2018 updates, aimed at improving overall beneficiary outcomes and enhancing patient engagement. Key objectives include:

– Enhancing clinician experience with a transparent, flexible program.
– Promoting the adoption of Advanced APMs.
– Maximizing understanding and participation through customized communication.
– Encouraging data sharing related to program performance.
– Improving IT systems for reporting and data submission.
– Supporting small and rural healthcare providers in program participation.

Highlights of MIPS 2018 Updates

Performance Period Changes

The performance period has been extended from 90 days to a full calendar year, with specific evaluations for Advancing Care Information and Improvement Activities still requiring a minimum of 90 days.

Performance Threshold Adjustments

The Minimum Performance Threshold is now set at 15 points, a significant increase from the previous threshold of 3 points. Clinicians can achieve this threshold through several criteria, including the submission of quality measures and Improvement Activities.

Quality Performance Measures

The 2018 Quality Measures Specifications will apply, with the final score now weighted at 50% instead of 60%. Clinicians must meet a minimum data completeness threshold of 60% to avoid penalties.

Improvement Activities Specifications

The weight of Improvement Activities has been set at 15% of the final score. Clinicians in small practices may need to report fewer high-weighted activities to achieve maximum points.

Advancing Care Information Requirements

Advancing Care Information contributes 25% to the final score. Clinicians can choose between the 2014 or 2015 edition of CEHRT, with additional bonuses for using the latter.

Cost Category Updates

The cost category will now account for 10% of the final score, utilizing total per capita cost measures and Medicare Spending per Beneficiary (MSPB) for evaluation.

Participation Options and Thresholds

Virtual Groups and Low-Volume Thresholds

CMS has introduced options for participation in Virtual Groups, allowing clinicians to collaborate virtually. The low-volume threshold has also been adjusted to exclude those with under $90,000 in allowed charges or less than 200 beneficiaries.

Hardship Exceptions

There are provisions for hardship exceptions for clinicians facing uncontrollable circumstances, including natural disasters and EHR decertification.

Conclusion and Future Outlook

Looking Ahead

As MIPS continues to evolve, it is crucial for healthcare providers to stay informed about updates and compliance requirements. The deadline for submitting hardship exception applications is December 31st, with the 2018 performance period submissions due by April 2, 2019.

For assistance with MIPS compliance and to ensure high performance scores, healthcare providers can contact P3 Healthcare Solutions for expert guidance. With CMS’s ongoing efforts to reduce reporting burdens, the QPP is expected to become increasingly clinician-friendly in the coming years.

Contact Information

For questions regarding MIPS or to get started, please reach out to a MIPS specialist at 1-844-557-3227 or email [email protected].