MIPS

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MIPS - Merit Based Incentive Payment System

MACRA repealed the Sustainable Growth Rate formula and created the Quality Payment Program. The Quality Payment Program changes the way Medicare pays clinicians and streamlines multiple quality programs. There are two options to choose from based on practice size, specialty, location or patient population. These are MIPS and APM (Advanced Alternative Payment Models). Most clinicians will be subject to MIPS unless they are in their 1st year of Part B participation, become QPs through participation in Advanced APMs, or have low volume of patients.

Who Does MIPS Affect? Medicare Eligible Clinicians

  • Physicians
  • Physician Assistants
  • Nurse Practioners
  • Clinical Nurse Specialists
  • Certified Nurse Anesthetists
  • Group that include such clinicians

CMS has provided a tool to see if you qualify for MIPS. Go to: https://www.cms.gov/Medicare/Quality-Payment-Program/Lookup-Tools/Lookup-tools.html

EXCLUSIONS

  • < 30k Part B
  • < = 100 Medicare Patients


MIPS has 4 Performance Categories

  • Quality (PQRS) – formerly Physician Quality Reporting System (30%)
  • Cost (VM) – formerly Value-Based Modifiers (30%)
  • ACI(MU) – formerly MU (25%)
  • Process Improvements (15%)


MIPS Reporting Periods - 2017

PATH 1 PATH 2 PATH 3
Requirements Report on 1+ quality measures IA: 90 days IA: 90 days
Report on 1+ IA measure ACI: 90+ days, less than 1 year ACI Full year
Report on All Base ACI measures Quality: 90+ days, less than 1 year Quality: Full year
Outcomes No penalty No penalty No penalty
No Incentive Proportion of potential incentive Full potential incentive

*** The more measures you report, the higher your score.


MIPS Reporting Periods - 2018

PATH 1 PATH 2
Requirements IA: 90 days IA: 90 days
ACI: 90+ days, less than 1 year ACI: Full year
Quality: Full year Quality: Full year
Outcomes Proportion of potential incentive/penalty Full potential

*** The more measures you report, the higher your score.

MIPS Scoring

MIPS Score will be determined by four Composite Performance Scores:

  • Quality – formerly PQRS measure (six or 15)
  • Cost – Formerly Value Based Modifiers
  • User of Health IT – formerly Meaningful User measure, now called ACI
  • Better Process – Improvement Activities (IA) new program

For additional information on scoring visit: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/MIPS-Scoring-101-Guide.pdf

Quality Category

 Choose 6 measure to report (was 9 with PQRS)
 Groups using web interface report 15 measures
 Each measure is worth  0-10 points (proportionally)
 Translates into 60% of MIPS score (year 1)

Cost Category

 Claims based calculation, no reporting necessary
 10 episode specific measures
 Each measure worth up to 10 points (based on cost efficiency, 20 patient sample min. for ea measure)
 Score is based on average performance across all calculated measures
 No weight in 2017, but results still reported to participants

IA Category - Focused on care coordination, beneficiary engagement, and patient safety

 Can earn up to 40 points
 Groups of >15 will receive 10 points for Medium weighted activities, 20 points for High weighted activities. Pick any of these: 
                                                                                                                  2 high-weighted activities 
                                                                                                                  4 medium-weighted activities 
                                                                                                                  1 high-weighted activity
                                                                                                                  2 medium-weighted activities
 Groups of <15 will receive 20 points for Medium weighted activities, 40 points for High weighted activities. Pick either of these: 
                                                                                                                  1 high-weighted activity 
                                                                                                                  2 medium-weighted activities

For additional information on IA – Improvement Activities visit: https://qpp.cms.gov/mips/improvement-activities


ACI – Advance Care Information – Base Score, Performance Score, and Bonus Score make up the ACI performance score.

Base Score 50% of ACI - All or nothing

Option 1 Threshold Option 2 Threshold
Security Risks Yes Security Risk Analysis Yes
E-prescribing >=1 pt/event E-presribing >=1 pt/event
Provide patient access >=1 pt/event Provide patient access >=1 pt/event
Send summary of care >=1 pt/event Send summary of care >=1 pt/event
Request/accept summary of care >=1 pt/event

***Exemptions: ePrescribing < 100, HIE < 100 transfer of care"""


Performance Score - There are two options for reporting performance score measure, based on 2014 CEHRT Edition or 2015 CEHRT Edition

2014 CEHRT = Report up to 9 ACI Measures 2015 CEHRT - Report up to 7 ACI Measures
Provide Patient Access Provide Patient Access
Patient-specific education Health information exchange
View, download, and transmit VDT View, download, transmit
Secure messaging Patient-specific education
Patient generated health data Secure messaging
Send summary of care Medication reconciliation
Request/accept summary of care Immunization registry
Clinical information reconciliation
Immunization registry reporting

See Advancing Care Information Fact Sheet on: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Advancing-Care-Information-Performance-Category-Fact-Sheet.pdf


Bonus Score - up to 5% bonus score

Option 1 Option 2
Syndromic Surveillance Reporting Syndromic Surveillance Reporting
Electronic case reporting Specialized registry reporting
Public health registry reporting
Clinical data registry

*** 10% bonus can be earned by using CEHRT to perform certain improvement activities

Scoring Summary

See Advancing Care Information Fact Sheet on: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Advancing-Care-Information-Performance-Category-Fact-Sheet.pdfhttps://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/MIPS-Measures-for-Primary-Care-Clinicians.pdf
Category Number of Measure Value of ea Measure Potential Maximum Score Max Score MIPS Score %
Quality 8 - 9 10 (measure scored proportionally) 80 - 90 80 - 90 50%
CPIA 90 10 or 20 Hundreds 60 15
Cost 40 10 (measure scored proportionally) Score based on % achieved for ea measure 10 10
ACI - BaseCost 6 All or nothing 80 100 25
ACI - Performance 8 10 (measure scored proportionally) 80
ACI - PHR 3 >0 = 1 1

See Advancing Care Information Fact Sheet on: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Advancing-Care-Information-Performance-Category-Fact-Sheet.pdf

https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/MIPS-Measures-for-Primary-Care-Clinicians.pdf