MIPS: A Value-Based Reimbursement Model Under MACRA

Overview of MIPS

The Merit-based Incentive Payment System (MIPS) is a value-based reimbursement model initiated by the Centers for Medicare & Medicaid Services (CMS) under the Medicare Access and CHIP Reauthorization Act (MACRA). This model aims to enhance healthcare quality while reducing costs. It empowers healthcare professionals to prioritize quality over quantity, leading to improved service delivery and the opportunity to earn incentives. Positive payment adjustments are available to those achieving scores above 15 out of 100 points.

Incentives for High Performers

Practitioners scoring above 70 can expect bonuses from a designated $500 million fund reserved for top performers. The MIPS program benefits various stakeholders, including physicians, insurance providers, and most importantly, patients who receive enhanced care. The Composite Performance Score (CPS) assesses each provider’s performance based on their reporting across four categories defined in the Quality Payment Program (QPP) for 2018.

Minimum Requirements of MIPS 2017

Introduction of MIPS

The practical implementation of MIPS commenced in 2017, marking a transitional phase for healthcare providers. By 2018, eligible practitioners were more informed about the procedures necessary to qualify for incentives, avoid penalties, and enhance their reputations within the healthcare sector.

Changes in Performance Categories

For 2018, the MIPS framework experienced a shift in scoring rules, increasing the number of measures across performance categories. The QPP 2018 provides an opportunity for practitioners to demonstrate their commitment to quality care, thereby earning incentives. The scoring distribution is as follows: Quality (60%), Improvement Activities (IAs) (25%), and Advancing Care Information (ACI) (15%). A MIPS final score of 3 or higher will prevent negative adjustments in 2019, requiring reporting on at least one quality measure, one improvement activity, or all ACI measures.

Basic Requirements in 2018

Updated Scoring Categories

In MIPS 2018, the scoring categories were adjusted as follows: Quality (50%), Improvement Activities (IAs) (15%), Promoting Interoperability (ACI) (25%), and Cost (10%). The updated regulations raised the stakes, requiring eligible practitioners to achieve at least 15 points to avoid penalties of up to 5% on Medicare Part B payments in 2020. To reach this threshold, practitioners must successfully report on 2-3 Quality measures, 4 Improvement Activities, or complete all ACI base measures.

Choosing the Right Measures

A MIPS Qualified Registry, such as P3Care, can assist practitioners in efficiently selecting appropriate measures.

Mathematical Side of MIPS

Importance of Quality Measures

Quality measures serve as a critical benchmark for MIPS 2018, contributing to the overall score by evaluating practitioners’ performance in their specific fields. Clinicians can select measures most relevant to their practice, with specialty-specific measure sets available for different disciplines.

Topped Out Objectives

CMS identified six ‘topped out’ Quality measures in 2018, indicating that eligible physicians can no longer score above 7 on these measures due to consistently high performance.

Measure Options for Eligible Clinicians in 2018

Eligible clinicians have access to multiple measure options:
– **Quality**: 271 measures available, from which six can be selected, including one outcome or high-priority measure.
– **Improvement Activities (IA)**: Report on up to four measures to achieve a maximum of 40 points.
– **Promoting Interoperability (PI)**: Previously known as Advancing Care Information (ACI), practitioners must report all four base measures to achieve the highest score.
– **Cost**: The Medicare Spending per Beneficiary (MSPB) category relies on claims data for scoring, with no measures to report.

Benefits of MIPS Participation

Incentives for High Performance

Successfully navigating all performance categories can yield 15 points, safeguarding practitioners from penalties in 2020. Exceeding the minimum measures, particularly outcome and high-priority measures, can qualify practitioners for bonuses from the $500 million incentive pool. Achieving 70 points positions clinicians among the elite, who prioritize patient care while benefiting from the program.

Win-Win for Stakeholders

The QPP 2018 framework offers advantages for various stakeholders. Clinicians benefit from positive payment adjustments, patients experience improved care, and the government takes pride in its effective policy structure.

MIPS 2019: A Brief Overview

Changes in Performance Measurement

As we enter the third performance year of MIPS, adjustments in performance measure percentages have occurred. The penalty level has increased to -7%, with the threshold to avoid penalties set at 30 points. The scoring distribution for 2019 is as follows:
– Quality: 45%
– Promoting Interoperability: 25%
– Improvement Activities: 15%
– Cost: 15%

Participation Guidelines

All eligible clinicians participating in Medicare Part B or Critical Access Hospital (CAH) Method II payments can engage in MIPS 2019, with options to report as a group or individually across all categories.

Opportunities for Incentives

Eligible clinicians have numerous opportunities to earn incentives through excellent performance in interoperability and quality measures, which ultimately reduce healthcare costs and enhance efficiency.

Contact for Assistance

As an approved MIPS registry, we can assist in reporting data on your behalf. For more information, please call 1-844-557-3227 (1-844-55-P3CARE) or email [email protected] to connect with a trained HIT consultant.